Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.


College of Health Care Sciences - Physical Therapy Department

First Advisor

Cheryl Hill

Second Advisor

Joshua Cleland

Third Advisor

Shane Koppenhaver

Publication Date / Copyright Date



Nova Southeastern University


Background and Purpose: Dry needling is becoming increasingly popular in the treatment of neuromusculoskeletal conditions. The neurophysiological effect of treatment, specifically those related to the sympathetic nervous system (SNS) is considered a relevant physiological mechanism contributing to a patient’s rehabilitation. The primary purpose of this study was toinvestigate the neurophysiological effects of dry needling, as measured by sympathetic outflow and muscular flexibility. A secondary purpose of this study was to determine if changes in SNS activity correlate with clinically meaningful improvements in pain and disability. Design: This was a prospective, double-blind randomized clinical trial. Subjects: The study sample consisted of 54 consecutive volunteers recruited from outpatient orthopedic clinics in Montgomery County, Maryland, who presented with low back pain and decreased hamstring length in at least one hamstring. Methods: Subjects completed a demographic questionnaire, the Numeric Pain Rating Scale and the Oswestry Disability Index (ODI). Afterward, they underwent local and remote muscle length testing, as well as pressure pain threshold (PPT) testing. Subjects were randomly allocated tothe treatment or placebo group. Measures of SNS activity were monitored and recorded before and after the treatment, and tests of muscle length and performance were re-assessed after treatment. Subjects returned 24 hours after their initial visit for muscle length testing, SNS testing, and to complete the Global Rating of Change, ODI, and Numeric Pain Rating Scale. Statistical Analysis: ANCOVAs were used for analysis of each variable of SNS activity as well as differences in local and remote flexibility. Differences between segmental and extra-segmental PPT changes were analyzed with a t-test. Pearson’s r was used to determine if there was a relationship between immediate SNS outflow and clinically meaningful improvements. Alpha levels for all statistical tests were p<.05. Results: Electrodermal activity (EDA) differed between groups immediately post-treatment (p=.002), and all other measures of sympathetic outflow were not significant. Local flexibility was greater in the DN group immediately post-treatment (p=.0495). There were no segmental differences in PPT after DN, and measures of SNS outflow immediately post-treatment did not correlate with improvements in pain and disability. Conclusion: DN can potentially result inimmediate changes in EDA and local flexibility.


Physical Therapy


dry needling, flexibility, low back pain, sympathetic nervous system

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