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A thorough examination to find myofascial trigger points (MTrPs) is required to characterise the clinical condition known as myofascial pain, which is descended from musculoskeletal pain and manifests with a referred component [1-3]. According to clinical definitions, MTrPs are sensitive nodules of spot tenderness that are hyperirritable and visible during physical examination and are situated in tight bands of skeletal muscle. The diagnosis of MTrPs is primarily based on the presence of three criteria, either alone or in combination: spot tenderness, transferred pain, and local twitch response (LTR), according to a recent research by Li et al [4]. Given that each criterion's reliability is linked to the muscle under study, using all of them together results in a more trustworthy diagnosis. In addition to physical examination, taut bands may be accurately identified by magnetic resonance, and electromyography can demonstrate the irritability brought on by MTrPs [3]. However, MTrPs still require an objective standard diagnosis.

Reduced range of motion, weakness, tiredness, referred spasm, inadequate post-exercise recovery, and modifications to motor activity patterns are the most frequent muscle dysfunctions that can be brought on by these MTrPs [5]. Different physical therapy methods, including as passive therapy, muscular strengthening, and stretching, have been effective in treating these muscle dysfunctions. In particular, multimodal therapies, such as dry needling (DN), appear to be dependable, safe, and economical for treating MTrPs [2]. In order to alleviate pain and dysfunction in neuromusculoskeletal diseases, Dunning et al. [6] state that DN "encompasses the insertion of needles without injectate into, beside, or around nerves, muscles, or connective tissues." In order to elicit LTR and physically disrupt MTrPs, DN is directly injected into MTrPs by injecting a small needle into the skin, subcutaneous tissues, and muscle without the use of any medicine. This method should be distinguished from wet needling or injection, which performs the needling while also administering an extra injection of analgesic chemicals, such as lidocaine. The fast-in fast-out or pistoning modality of DN applied to the MTrPs is the one that is most frequently employed and involves repeatedly and quickly inserting the needle into the MTrPs region in the form of a fan or cone to induce LTR. A thorough examination of the advantages of DN application on the triceps surae is still required, despite previous reviews and metaanalyses discussing the effectiveness of DN on particular myofascial painrelated variables (highlighting its effect on reducing pain, increasing range of motion (ROM), and reducing tone) and for the treatment of MTrPs in different muscles of the lower extremity). For functional tasks including walking and balance, the triceps surae muscles must be actively involved. Increased dorsiflexion range of motion (ROM), force output to produce elastic energy, and reduced pronation upon weight acceptance are all indicators of adequate flexibility of these muscles. Increased dorsiflexion range of motion, for instance, affects the pre-stretching of the ankle plantar flexors during landing leaps, optimising the use of elastic energy and boosting jump function, serving as injury prevention.

Conclusion

Despite a growth in recent years in studies on the use of DN of MTrPs in the triceps surae muscles, concrete scientific proof of its efficacy is still missing. However, this systematic review offers the initial information regarding the use of DN of MTrPs in the triceps surae muscles. Our data imply that this technique could improve functional outcomes and muscular stiffness. Since muscle stiffness may likely be a risk factor for muscular damage, the favourable results on muscle stiffness might stimulate the incorporation of DN in clinical practise. Results on the effects of conventional therapy, sham needling, and no intervention on musculoskeletal discomfort, range of motion, and muscular strength were equivocal. Significant findings were achieved in favour of the control groups when it came to pressure pain thresholds. This may be explained by the occurrence of postneedling- induced discomfort, which is the most frequent mild adverse event following intervention and may have a detrimental impact on the outcomes. Despite these findings, they should be interpreted with caution because to the person, DN procedure, and control group variability. Therefore, future studies must use carefully thought-out study methodologies. In order to ascertain the short- and long-term effects of DN of MTrPs in the triceps surae muscles, we advise authors to conduct randomised controlled studies with follow-up assessments. To incorporate this strategy into clinical practise, more research will be needed. This article emphasises the need for more investigation into the underlying processes of DN and may serve as the foundation for future clinical trials.

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2. Barbero M, Schneebeli A, Koetsier E, Maino P (2019) Curr Opin Support Palliat Care 13: 270-276.

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3. Celik D, Mutlu EK (2013) Curr Pain Headache Rep 17: 1-7.

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4. Li L, Stoop R, Clijsen R, Hohenauer E, Fernandez-De-Las-Penas C (2020) Clin J Pain 36: 955-967.

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5. Lucas KR, Polus BI, Rich PA (2004) J Bodyw Mov Ther 8: 160-166.

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6. Dunning J, Butts R, Mourad F, Young I, Flannagan S, et al. (2014) Phys Ther Rev 19: 252-265.

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