Deep dry needling enhances jump performance in elite beach volleyball players

Abstract

The present study aims to assess whether Deep Dry Needling in latent Myofascial Trigger Points is associated with changes in jumping performance. Six Under-21 international players from the ten that belong to the national beach volleyball team received intervention in vastus lateralis and medialis of the quadriceps. Three squat jump (SJ) and countermovement jump (CMJ) trials were measured in four sessions: pre-and post-intervention (acute effect), 48 h and 7 days after intervention (long-term effects). The players showed a small decrease after the intervention followed by a non-significant increase at 48 h. However, both jump types resulted in very likely moderate increase after one week of intervention: 4.13 cm (+10.8%) and 3.54 cm (+8.9%) for SJ and CMJ, respectively (3 times the smallest worthwhile change). Despite this significant increase, the decreased performance in post-test results discourages practitioners from using this technique just before a competition. Rev.int.med.cienc.act.fís.deporte-vol.

Full text

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
523
Jiménez-Olmedo, J.M.; Grau-Aracil, A.; Penichet-Tomás, A. y Pueo, B. (2022) Deep Dry Needling
Enhances Jump Performance in Elite Beach Volleyball Players. Revista Internacional de
Medicina y Ciencias de la Actividad Física y el Deporte vol. 22 (87) pp. 523-534
Http://cdeporte.rediris.es/revista/revista87/artpuncion1371.htm
DOI: https://doi.org/10.15366/rimcafd2022.87.006
ORIGINAL
DEEP DRY NEEDLING ENHANCES JUMP
PERFORMANCE IN ELITE BEACH VOLLEYBALL
PLAYERS
LA PUNCIÓN SECA AUMENTA EL RENDIMIENTO DE
SALTO EN JUGADORES ÉLITE DE VÓLEY PLAYA
Jiménez-Olmedo, J.M.1; Grau-Aracil, A.2; Penichet-Tomás, A.1; Pueo, B.1
1 Facultad de Educación, Universidad de Alicante (Spain) j.olmedo@ua.es,
alfonso.penichet@ua.es, basilio@ua.es
2 Clínica Campos Fisioterapia, 03540-Alicante (Spain) anagrar7@gmail.com
Spanish-English translator: Elena Gandía García, Department of World Languages
and Cultures, at the University of Nevada, Las Vegas, NV, USA, elena.gandia@unlv.edu
Código UNESCO / UNESCO code: 5899 Otras especialidades (Educación
Física y Deporte) / Other specialities (Physical Education and Sports)
Clasificación del Consejo de Europa / Council of Europe Classification:
11. Medicina del deporte / Sports Medicine.
Recibido 12 de abril de 2020 Received April 12, 2020
Aceptado 26 de septiembre de 2020 Accepted September 26, 2020
ABSTRACT
The present study aims to assess whether Deep Dry Needling in latent
Myofascial Trigger Points is associated with changes in jumping performance.
Six Under-21 international beach volleyball players received intervention in
vastus lateralis and medialis of the quadriceps. Three squat jump (SJ) and
countermovement jump (CMJ) heights were measured in four sessions: pre-
and post-intervention (acute effect), 48 h and 7 days after intervention (long-
term effects). The players showed a small decrease after the intervention
followed by a non-significant increase at 48 h. However, both jump types
resulted in very likely moderate increase after one week of intervention: 4.13 cm
(+10.8%) and 3.54 cm (+8.9%) for SJ and CMJ, respectively (3 times the
smallest worthwhile change). Despite this significant increase, the decreased
performance in post-test results discourages practitioners from using this
technique just before a competition.

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
524
KEYWORDS: Myofascial Trigger Points; Long-term effects; Intervention,
Muscle, Magnitude Based Inference, MBI
RESUMEN
El objetivo del presente estudio es evaluar si la aplicación de la punción seca en
los puntos gatillo miofasciales latentes se asocia con cambios en el rendimiento
de salto. Seis jugadores internacionales de los diez que forman el equipo
nacional de vóley playa sub 21 recibieron tratamiento en el vasto lateral y medial
de los cuádriceps. Se midieron tres pruebas de salto SJ y CMJ en cuatro
sesiones: antes y después de la intervención (efecto agudo), 48 h y 7 días tras
la intervención (efectos a largo plazo). Los jugadores mostraron una pequeña
disminución post-intervención seguida de un aumento no significativo a las 48h
en los valores de altura de salto registrados. Sin embargo, ambos tipos de salto
dieron lugar a un aumento en la altura de salto con efecto moderado muy
probable después de una semana de la intervención: 4,13 cm (+10,8%) y 3,54
cm (+8,9%) para SJ y CMJ, respectivamente. A pesar de este aumento
significativo, la disminución del rendimiento posterior a la prueba desalienta su
uso justo antes de una competición.
PALABRAS CLAVE: puntos gatillo miofasciales; efectos a largo plazo;
intervención, músculo, inferencia basada en magnitudes, MBI
INTRODUCTION
Beach volleyball is a sport modeled by a number of external factors such as
environmental conditions, playing surface or air temperature and also by
specific game rules which can condition the performance of athletes (Jimenez-
Olmedo & Penichet-Tomas 2017). This is a sport where some specific
performance indicators are directly related to the success of the match. For
instance, the number of points won in each game, the relation between points
and errors by game actions, and the coefficient of game actions performance
allows for explaining the factors between winning and losing in beach volleyball
matches (Medeiros et al. 2017). With regards to internal factors, the physical
demands of beach volleyball are age-related and therefore, elite level demands
cannot be extrapolated to the rest of lower levels. Researchers have reported
an increase in the demands of the game regarding differences in relation to the
temporal variables of the game and physical variables as a function of the age
of athletes (Medeiros, Marcelino, Mesquita, & Palao, 2014).
On the other hand, of the different technical elements that exist and must be
developed by athletes, jumping is the most important technical action in beach
volleyball, since it is directly related to performance and fitness. In addition,
jumping is especially important in this sport, as it is performed in combination
with other decisive technical actions such as serve, block, spike, and shot.
Jump execution is determined by the athlete's physical ability and coordination
on the playing surface and has become a key skill in beach volleyball

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
525
performance. Several factors can affect the athlete's ability to jump by reducing
muscle flexibility and strength: muscle injuries like muscle tightness or previous
muscle injuries, age, ethnicity, strength imbalances, reduced flexibility, fatigue,
knee injuries, or high BMI. Among these factors, Myofascial Trigger Points
(MTrPs) have been reported to show a negative influence on the correct
functioning of the motor activity. MTrPs can be active, causing spontaneous
pain and being painful upon palpation or latent, which are only painful to
palpation with no spontaneous pain (Hsieh, Yang, Liu, Chou, & Hong, 2014).
Three major interventions can be established for an effective treatment for
MTrPs: a) Clinician or patient-administered manual therapy like passive
rhythmic release, active rhythmic release, or trigger-point pressure release; b)
Clinician-administered manual therapy like spray and stretch; c) Needle therapy
like dry needling or injections (Simons 2004). The latter intervention has usually
been applied for the treatment of pain in different regions of the body (Liu et al.
2018), as well as for the rehabilitation of dysfunctional areas (Rainey 2013;
Cross & McMurray 2017).
Recently, dry needling has been started to use in the treatment and recovery of
athletes, such as volleyball athletes with acute shoulder injuries during
competitive periods with high intensity and training load, who reported short-
term pain relief and improved active shoulder ROM after treatment (Osborne &
Gatt, 2010). Further, the acute effect of dry needling treatment has also been
studied on a chronic golfer’s elbow disability reporting an improvement in the
athlete's physical performance within 48 hours of treatment (Shariat et al.
2018). Researchers have also demonstrated that a combination of dry needling
with specific strength training can help athletes to recover and improve
hamstring strain (Dembowski, Westrick, Zylstra, & Johnson, 2013). Although dry
needling is a treatment with positive effects on pain relief, the effect on sports
performance is still relatively unexplored. Some studies have found an increase
in jump height only after the intervention (Bandy, Nelson, & Beamer, 2017),
after the intervention and 48 hours later (Devereux, O’Rourke, Byrne, Byrne, &
Kinsella, 2018), while others have not been able to identify clinically significant
improvements in the intervention (Geist et al., 2017).
However, no studies have attempted to analyze the acute and long-term effect
of this type of treatment on athletes’ performance. Therefore, the aim of the
present study was to assess whether Deep Dry Needling (DDN) in latent MTrPs
of the vastus lateralis and medialis is associated with changes in jumping
performance in Under-21 international Beach Volleyball players.
METHOD
SUBJECTS
This study performed uncontrolled clinical trials with six Under-21 (2 blockers
and 4 diggers) international male beach volleyball players. All participants were
specialist beach volleyball players (not playing in related disciplines like indoor
volleyball) with a minimum training experience of 4 years (body mass:
75.3±11.3 kg, height: 184.7±7.8 cm, and body mass index: 21.8±2.1 kg/m2).
They performed weekly specific training consisting of 9 hours in the gym and 14

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
526
hours in the sand, consisting of combined technical and tactical aspects with
specific training exercises of power, jump, speed, and agility.
DATA COLLECTION
Jump heights were collected with a validated open-source jump-map system
(Chronojump Boscosystem, Barcelona, Spain), which comprises a rigid platform
connected to a computer via a tailored signal adapter (Pueo, Lipinska, Jiménez-
Olmedo, Zmijewski, & Hopkins, 2017). The jump-mat registered flight times (t)
with a temporal resolution of 1 ms and used the kinematic equation h=t2·g/8 in
order to compute jump height h, where g is the gravity acceleration (9.81 m/s2).
For the dry needling intervention, specific surgical steel physiotherapy needles,
sized 0.30 mm x 50 mm, were employed (Agupunt, Barcelona, Spain). The
intervention was made following specific protocols (Hong & Simons 1998).
PROCEDURES
A prospective longitudinal study design was conducted with elite players in a
single experimental group. Given the population of under 21 elite beach
volleyball players at the national level and the type of invasive intervention they
received, it was decided to apply an intervention in a pre-time series and
several post sessions to a unique experimental group of 6 players. A controlled
trial was logistically difficult as the number of subjects per group would have
been very low. To assess the effect of deep dry needling, the following specific
protocol was performed. First, participants were selected following these
criteria: beach volleyball players must be part of specific beach volleyball
training programs and they must show clinical features of myofascial trigger
points (MTrPs). Players who showed any of the following situations were
excluded from the study: spontaneous lower limp pain, unsurmountable fear of
needles, blood coagulation alterations, and lack of player agreement. A
diagnostic physical examination was performed to identify myofascial trigger
points (MTrPs) by means of four manifestations (Simons 2004): a) Taud band;
b) Focal sport muscle tenderness; c) Pressure-elicited referred pain pattern; d)
If active, pressure elicits symptoms recognized as familiar.
All selected athletes were informed about the experimental protocol and
procedures of the study and they were also given written informed consent that
they voluntarily signed. The Ethics Committee at the University of Alicante gave
institutional approval to this study, in accordance with the Declaration of
Helsinki (IRB UA-2018-10-16).
The vertical jump test consisted of jump height measurements in four sessions:
pre- and post-intervention to account for acute effects of treatment, and 48 h
and 7 days after interventions to look into long-term effects. Specifically, each
athlete performed trials of squat jump (SJ) and countermovement jump (CMJ)
tests in a jump mat system. Squat Jump started with knees bent at 90º and with
hands on hips to avoid the arm contribution to the jump. Countermovement
jumps started with hands on hips from standing position allowing for
countermovement up to 90º knee bending followed by jump (Sánchez-Sixto,

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
527
Harrison, & Floría, 2019). Athletes performed three trials of each jump, and the
best one was employed for statistical analysis. To avoid muscle fatigue, 2-
minute rest time between the 3 repetitions of SJ, followed by a 5-minute rest
time before starting the series of CMJ jumps. SJ and CMJ trials showed ICC
values of 0.95 and 0.96, and CV values of 4.2% and 2.9%, respectively, which
demonstrated consistency in athletes’ performance.
The dry needling intervention was carried out the first day after baseline jump
measures (pre-intervention). After leaving a complete rest of 5 minutes, the
athletes were intervened with dry needling. Beach volleyball athletes were
placed in a supine decubitus position with the quadriceps in relaxation. After
detecting the trigger point, the area to be punctured was disinfected with
antiseptic. Then, 20 insertions maximum and 2 local twitch responses (LTRs) of
deep dry needling in MTrP in vast lateral and medial of the quadriceps were
performed by a professional physiotherapist with six-year experience, followed
by compression for 30 seconds over the treated area. The vast medial and the
vast lateral were selected to perform the intervention since these two muscle
heads produce twice as potential’s action than any other part of the quadriceps
(Hong & Simons, 1998).
After a 10-minute rest after the intervention, a jump assessment was carried out
again as a post-test. Finally, to evaluate the effect of the dry needling
intervention, the jump protocol described above was repeated 48h after the dry
needling intervention and 7 days later.
DATA ANALYSIS
Mean and standard deviation values were used for descriptive analysis. The
Kolmogorov-Smirnov test was performed to test for normal distribution. Pre- and
post-intervention, 48 hours and 7 days comparisons of the jump heights were
performed using the paired samples t-test. Values of p<0.05 were considered to
indicate statistical significance. To test the stability of the athlete’s performance,
the coefficient of variation (CV) and Intraclass Correlation Coefficient (ICC)
were used. Contrast results were interpreted using both the modified Cohen’s d
(Hedges), where 0.2, 0.5 and 0.8 stands for small, moderate and large,
respectively, and also by means of magnitude-based inference (MBI), where
<0.1, 0.2, 0.6 and 1.2 stands for trivial, small, moderate and large, respectively
(Hopkins, Marshall, Batterham, & Hanin, 2009). MBI is based on 90%
confidence intervals (CI) that represent the uncertainty in the true value of the
jump improvement. Three scales can be defined according to the minimum
improvement likely to have a practical impact, also known as the smallest
worthwhile change (SWC): substantially positive, trivial, and substantially
negative (Buchheit, 2016). Chances that the true values lay on these scales are
calculated by comparison with CI: if the chance that the true values do not
overlap positive and negative ranges substantially, then the magnitude of the
observed value is estimated with the following probabilistic terms: possibly, 25-
75%; likely, 75-95%; very likely, 95-99.5% and most likely, >99.5%. The SWC
to look for meaningful jump height variations has been set up to 20% of
between-sessions pooled SD. An available spreadsheet (Hopkins, 2007) was
used to calculate mechanistic inferences and, confident limits.

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
528
All vertical jump heights during post-test, after 48 hours, and after 7 days were
compared to baseline values during pre-test. Meaningful differences were
identified when mean values were lower or higher than SWC (depicted in grey
area in plots) and when their limits of 95% confidence intervals (CI) did not
intersect SWC area, representing trivial changes.
RESULTS
For the first jump type (SJ), the pre-test jump height mean value before
intervention was 38.15 cm, considering as a baseline to which compare the rest
of jump heights, as shown in Table 1. Just after intervention, there was a likely
decrease in jump height of 1.75 cm (-4.58%), which can be due to the post-
intervention pain in the treated muscle. After 48 hours, there was a slight
improvement of 1.80 cm (+4.71%), although possibly trivial, which suggest that
athletes have reached similar values to pre-test. Finally, a possibly large
improvement of 4.13 cm (+10.82%) was observed in the evaluation carried out
after 7 days.
Table 1. Average jump performance across the different sessions, along with mean
difference, magnitude-based inferences (MBI), and Cohen's corrected effect size for
changes in jump height from pre-test values. [95% CI] is indicated where appropriate.
Jump
Variable
Pre-test
Post-test
48 h
7 days
SJ
Jump height
(cm)
38.15
[36.08 – 40.89]
36.40
[34.33 – 38.12]
39.95
[35.15 – 44.97]
42.28
[39.25 – 45.38]
Mean
difference (cm)
-1.75
[-2.90 − -0.60]
1.80
[-1.86 – 5.46]
4.13
[2.57 – 5.69]
Mean
difference (%)
-4.58 4.71 10.82
MBI
Small**
Trivial*
Moderate***
d
0.64
[-1.91 – 2.62]
0.39
[-4.73 – 2.93]
0.89
[-4.23 – 3.44]
ES
Moderate
Small
Large
CMJ
Jump height
(cm)
39.58
[37.32 – 41.67]
38.78
[36.67 – 40.56]
40.33
[35.89 – 44.88]
43.12
[39.98 – 46.09]
Mean
difference (cm)
-0.79
[-1.52 − -0.06]
+0.75
[-2.81 – 4.30]
+3.54
[1.95 – 5.13]
Mean
difference (%)
-2.02 1.89 8.94
MBI
Small*
Trivial**
Moderate***
d
0.32
[-1.97 – 2.37]
0.18
[-4.53 – 2.47]
1.12
[-2.04 – 3.41]
ES
Small
Trivial
Large
95% CI: confidence intervals, Limits of Cohen's d scale and MBI: <0,1, 0,2, 0,6 and 1,2
for trivial, small, moderate and large, respectively, *25-75%, possible; **75-95%,
probable; ***95-99,5%, very probable.

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
529
With respect to CMJ, the mean pre-test jump height for CMJ was 39.58 cm and,
similarly to SJ, there was a possibly decreased in jump height of 0.79 cm (-
2.02%) than pre-test. Again, the residual muscle pain for the deep dry needling
may prevent athletes to reach baseline values. After 48 hours, there was a likely
trivial decreased improvement of 0.75 cm (+1.89%), followed by a possibly
large rise in jump height of 3.54 cm (+8.94%) after 7 days from intervention.
With regards to graphical interpretation of meaningful differences in jump height
as a consequence of the deep dry needling across the four stages, Figure 1
shows the vertical jump performances for SJ and CMJ. In the right axis, the
three numbers denote the chances for the change to be a decrease/no
change/increase and a qualitative probabilistic mechanistic inference about the
true effect of the jump performance. The SWC, depicted in grey area in the plot,
was set to 0.66 and 0.58 cm for SJ and CMJ, respectively, as 20% of between-
sessions pooled SD.
Figure 1: Interpretation by magnitude-based inferences of significant changes in SJ and CMJ
jump height performances in elite beach volleyball players after dry needling intervention. The
left axis shows the differences in jump height (95% confidence intervals) between pre-test and
post-test, 48 h and 7 days. The right axis shows the percentage probability that the change is
negative / no change / positive (jump height decrease / no change / increase) and the
associated qualitative probabilistic mechanical inference.
DISCUSSION
In this study, we quantified the acute and long-time effects of deep dry needling
in latent Myofascial Trigger Points (MTrP) of vastus lateralis and medialis in
jump performance of elite beach volleyball players. Although MTrP treatment is
used to relieve pain and release trigger points in the muscle, that release can
lead to improvements in muscle activity, resulting in a direct increase in jump
height. The results demonstrated that such an intervention followed by 7 days
allowed players to increase jump height with possibly large effect (3 times the
smallest worthwhile change).
Beach volleyball is a sport characterized by intermittent short-period maximum
efforts with fast and skilled executions on sand that are interspersed with
frequent explosive vertical jumps (Oliveira et al. 2018). The combination of the
above dynamic exercise and isometric contractions found in technical actions
like spike, defense, setting or serve, may induce muscle fatigue and reduction
of the maximum voluntary contraction force, thus causing MTrPs (Yu & Kim
2015). Particularly in beach volleyball, the existence of MTrPs can affect the

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
530
motor capacity of muscles and therefore the ability to jump. Thus, the
elimination of latent MTrPs may effectively reduce accelerated muscle fatigue
and prevent overload spreading within a muscle (Ge, Arendt-Nielsen, &
Madeleine, 2012). The treatment of MTrPs with the deep dry needling has been
extensively studied as pain relief, but the effect of such a technique on sports
performance is still relatively unexplored (Devereux et al. 2018).
For interventions performed using dry needling, the pain reduction in the days
after treatment was accompanied by adverse effects, such as soreness after
needling, local hemorrhages, and syncopal responses (Kalichman & Vulfsons
2010). These adverse effects, together with the post-puncture pain, may explain
the drop in jumping height of the athletes evaluated in the intervention. After 48
hours, SJ and CMJ jump height values approximately returned to pre-test, with
minor trivial improvements. Other studies showed different degrees of jump
increase after the intervention and after 48 hours. Geist et al. (2017)
investigated the effectiveness of dry needling on hamstring flexibility and a
series of jump tests as measures of functional performance, compared to blunt
needles. They were unable to identify clinically significant improvements from
the intervention. In another study on the treatment of pain in an athlete with
more than 20 years of experience and diagnosed with tennis elbow, a single
session with dry needling, reported an improvement 48 hours after treatment,
being able to carry out a return to training with elastic bands without pain 7 days
later (Shariat et al., 2018). Otherwise, Devereux et al. (2018) published a paper
investigating the effect of dry needling on gastrocnemius, rectus femoris,
combined muscles with controls on SJ jump performance at 5 incremental
loads. They identified a significant increase in the gastrocnemius muscle group
only immediately after the intervention and 48 hours later. Bandy et al. (2017)
compared the effect of dry needling with the placebo group on the performance
of the vertical jump applied to the gastrocnemius muscles, increasing the height
of the vertical jump after the intervention. For the latter and in the sample of our
study, the gradual improvement in hemodynamics may explain the improvement
in response on days 1 to 3 after treatment (Jimbo, Atsuta, Kobayashi, &
Matsuno, 2008).
Researchers have also demonstrated that pain begins to disappear after
treatment, but it is necessary to wait a week for the muscle to fully recover its
functionality (Lee, Chen, Lee, Lin, & Chan, 2008). This muscle function recovery
after dry needling intervention to eliminate the MTrPs could explain the
improvement in jump heights for SJ and CMJ. In addition to reduced pain
inhibition of movement, the needle stretching of muscle fibers allows for a
normal length resume (Osborne & Gatt, 2010).
Although these results suggest a direct improvement of jumping capacity, there
are several factors that hinder the generalized use of this type of technique. The
first factor is the low sample size of this study of elite players, which precluded
the use of a placebo or control group. It would also be beneficial to complete a
follow-up evaluation after seven days to address the effects of the intervention.
Similarly, it would be necessary to evaluate the general and unwanted
performance effects of continued use of this type of technique, especially the
duration of pain after treatment and its effect on healthy athletes. In addition, it

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
531
is necessary to have specialized personnel to carry out the dry needling
technique properly and safely. On the other hand, pain after the intervention
can condition the training routine of athletes and even force them to interrupt
their training. Also, invasive techniques are often rejected by athletes who
prefer to receive other types of classical and painless treatments such as
manual therapy. However, this treatment can provide possibilities in moderate
use at specific times, so that athletes can be prepared and optimized for
specific events, competitions, or specific matches. Therefore, its application in
athletes can be considered for the improvement of muscular activity.
CONCLUSION
The treatment of latent MTrPs through deep dry needling in healthy beach
volleyball athletes has shown acute and long-time effects on leg muscle
response. Just after the intervention, jump height likely decreased due to the
soreness in their muscles. This decrease in post-test performance discourages
practitioners from using deep dry needling before competitions. When pain
disappeared after 48 hours, jump performance rose to pre-test levels but the
effect was trivial. However, in the tests performed after 7 days from intervention,
there was a possibly large increase in jump performance with jump heights
around 10% larger than pre-intervention. In conclusion, the treatment of latent
MTrPs with deep dry needling has shown long-term positive effects on the
musculature of the vast lateral and vast medial quadriceps, obtaining jump
improvements in SJ and CMJ tests 7 days after treatment. In future studies,
similar enhancements may be observed for other muscle groups in jumping
performance.

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
532
REFERENCES
Bandy, W. D., Nelson, R., & Beamer, L. (2017). Comparison of dry needling vs.
sham on the performance of vertical jump. International Journal of Sports
Physical Therapy, 12(5), 747–751. https://doi.org/10.26603/ijspt20170747
Buchheit, M. (2016). The Numbers Will Love You Back in Return — I Promise.
International Journal of Sports Physiology and Performance, (11), 551–
554.
Cross, K. M., & McMurray, M. (2017). Dry needling increases muscle thickness
in a subject with persistent muscle dysfunction: A case report. International
Journal of Sports Physical Therapy, 12(3), 468–475.
Dembowski, S. C., Westrick, R. B., Zylstra, E., & Johnson, M. (2013). Treatment
of hamstring strain in a collegiate pole-vaulter integrating dry needling with
an eccentric training program: A resident’s case report. International
Journal of Sports Physical Therapy, 8(3), 328–339.
Devereux, F., O’Rourke, B., Byrne, P. J., Byrne, D., & Kinsella, S. (2018). The
effects of myofascial trigger point release on the power and force
production in the lower limb kinetic chain. Journal of Strength and
Conditioning Research, 33(9), 2453–2263.
https://doi.org/10.1519/JSC.0000000000002520
Ge, H. Y., Arendt-Nielsen, L., & Madeleine, P. (2012). Accelerated muscle
fatigability of latent myofascial trigger points in humans. Pain Medicine
(United States), 13(7), 957–964. https://doi.org/10.1111/j.1526-
4637.2012.01416.x
Geist, K., Bradley, C., Hofman, A., Koester, R., Roche, F., Shields, A., …
Johanson, M. (2017). Clinical effects of dry needling among asymptomatic
individuals with hamstring tightness: A randomized controlled trial. Journal
of Sport Rehabilitation, 26(6), 507–517. https://doi.org/10.1123/jsr.2016-
0095
Hong, C.Z., & Simons, D. G. (1998). Pathophysiologic and electrophysiologic
mechanisms of myofascial trigger points. Archives of Physical Medicine
and Rehabilitation, 79(7), 863–872.
Hopkins, W. G. (2007). A spreadsheet for deriving a confidence interval,
mechanistic inference and clinical inference from a p value. Sportscience,
11, 16–20.
Hopkins, William G., Marshall, S. W., Batterham, A. M., & Hanin, J. (2009).
Progressive statistics for studies in sports medicine and exercise science.
Medicine and Science in Sports and Exercise, 41(1), 3–12.
https://doi.org/10.1249/MSS.0b013e31818cb278
Hsieh, Y. L., Yang, C. C., Liu, S. Y., Chou, L. W., & Hong, C. Z. (2014). Remote
dose-dependent effects of dry needling at distant myofascial trigger spots
of rabbit skeletal muscles on reduction of substance P levels of proximal
muscle and spinal cords. BioMed Research International, 2014.
https://doi.org/10.1155/2014/982121
Jimbo, S., Atsuta, Y., Kobayashi, T., & Matsuno, T. (2008). Effects of dry
needling at tender points for neck pain (Japanese: Katakori): Near-infrared
spectroscopy for monitoring muscular oxygenation of the trapezius. Journal
of Orthopaedic Science, 13(2), 101–106. https://doi.org/10.1007/s00776-

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
533
007-1209-z
Jimenez-Olmedo, J. M., & Penichet-Tomas, A. (2017). Blocker’s activity at
men’s european beach volleyball university championship: Actividad de los
bloqueadores durante el Campeonato de Europa Universitario de vóley
playa. Retos. Nuevas Tendencias En Educacion Física, Deporte y
Recreación, 32, 252–255.
Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of
musculoskeletal pain. The Journal of the American Board of Family
Medicine, 23(5), 640–646. https://doi.org/10.3122/jabfm.2010.05.090296
Lee, S. H., Chen, C. C., Lee, C. S., Lin, T. C., & Chan, R. C. (2008). Effects of
needle electrical intramuscular stimulation on shoulder and cervical
myofascial pain syndrome and microcirculation. Journal of the Chinese
Medical Association, 71(4), 200–206. https://doi.org/10.1016/S1726-
4901(08)70104-7
Liu, L., Huang, Q. M., Liu, Q. G., Thitham, N., Li, L. H., Ma, Y. T., & Zhao, J. M.
(2018). Evidence for dry needling in the management of myofascial trigger
points associated with low back pain: A systematic review and meta-
analysis. Archives of Physical Medicine and Rehabilitation, 99(1), 144–152.
https://doi.org/10.1016/j.apmr.2017.06.008
Medeiros, A., Marcelino, R., Mesquita, I. M., & Palao, J. M. (2017). Performance
differences between winning and losing under-19, under-21 and senior
teams in men ’ s beach volleyball. International Journal of Performance
Analysis in Sport, 17(1–2), 1–13.
https://doi.org/10.1080/24748668.2017.1304029
Medeiros, A., Marcelino, R., Mesquita, I., & Palao, J. M. (2014). Physical and
temporal characteristics of under 19, under 21 and senior male beach
volleyball players. Journal of Sports Science and Medicine, 13(3), 658–665.
Oliveira, W. K., Jesus, K. de., Andrade, A. D., Nakamura, F. Y., Assumpção, C.
O., & Medeiros, A. I. (2018). Monitoring training load in beach volleyball
players: a case study with an olympic team. Motriz: Revista de Educação
Física, 24(1), 1–8. https://doi.org/10.1590/s1980-6574201800010004
Osborne, N. J., & Gatt, I. T. (2010). Management of shoulder injuries using dry
needling in elite volleyball players. Acupuncture in Medicine : Journal of the
British Medical Acupuncture Society, 28(1), 42–45.
https://doi.org/10.1136/aim.2009.001560
Pueo, B., Lipinska, P., Jiménez-Olmedo, J. M., Zmijewski, P., & Hopkins, W. G.
(2017). Accuracy of jump-mat systems for measuring jump height.
International Journal of Sports Physiology and Performance, 12(7), 959–
963. https://doi.org/10.1123/ijspp.2016-0511
Rainey, C. E. (2013). The use of trigger point dry needling and intramuscular
electrical stimulation for a subject with chronic low back pain: a case report.
International Journal of Sports Physical Therapy, 8(2), 145–161.
Sánchez-Sixto, A., Harrison, A. J., & Floría, P. (2019). Importance of
countermovement depth in stretching and shortening cycle analysis.
Revista Internacional de Medicina y Ciencias de la Actividad Fisica y del
Deporte, 19(73), 33–44. https://doi.org/10.15366/rimcafd2019.73.003
Shariat, A., Noormohammadpour, P., Memari, A. H., Ansari, N. N., Cleland, J.
A., & Kordi, R. (2018). Acute effects of one session dry needling on a
chronic golfer’s elbow disability. Journal of Exercise Rehabilitation, 14(1),

Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354
534
138–142. https://doi.org/10.12965/jer.1836008.004
Simons, D. G. (2004). Review of enigmatic MTrPs as a common cause of
enigmatic musculoskeletal pain and dysfunction. Journal of
Electromyography and Kinesiology, 14(1), 95–107.
https://doi.org/10.1016/j.jelekin.2003.09.018
Yu, S. H., & Kim, H. J. (2015). Electrophysiological characteristics according to
activity level of myofascial trigger points. Journal of Physical Therapy
Science, 27(9), 2841–2843. https://doi.org/10.1589/jpts.27.2841
Número de citas totales / Total references: 26 (100%)
Número de citas propias de la revista / Journal's own references: 1 (3,4%)
Rev.int.med.cienc.act.fís.deporte - vol. 22 - número 87 - ISSN: 1577-0354