Effectiveness of percutaneous intratissue electrolysis and deep dry needling compared to a standard physiotherapy protocol in the treatment of whiplash syndrome

Rocío Fernández-Navarro^1,2*María Benito-de-Pedro¹Francisco-Manuel Navarro-Reyes^2,3Jorge Moreno-López²María-José Estebanez-Pérez³Jose-Manuel Pastora-Bernal⁴

• ¹Camilo José Cela University, Madrid, Spain
• ²Hospital Universitario de Melilla, Melilla, Spain
• ³Faculty of Health Sciences of Melilla, University of Granada, Melilla, Spain
• ⁴Universidad de Malaga, Mlaga, Spain

Background: Whiplash syndrome is one of the most frequent consequences of traumatic pathology caused traffic accidents. The acceleration-deceleration mechanism of energy transmitted to the neck causes abnormal maneuvers in the area and muscle pain. The most common form of muscle pain in the neck and head is myofascial pain syndrome, caused by myofascial trigger points, these being clinically defined as painful, sensitive and hyperirritable nodules that are located on tense muscle bands. These painful nodules are treated with different physiotherapy techniques, there being no international consensus regarding their diagnosis and recommended interventions. Objective: The primary objective of this study is to evaluate the effectiveness of percutaneous intratissue electrolysis (EPI) on intrafibrillar blood flow and muscle fiber elasticity compared to deep dry needling (DN) and standard physiotherapy. Secondary objectives include the assessment of perceived pain, disability, and clinical outcomes at follow-up. Methods: This single-blind randomized clinical trial will be conducted in patients residing in Melilla with whiplash syndrome due to traffic accidents. Participants will receive interventions targeting the sternocleidomastoid and/or levator scapulae muscles. Assessments will be conducted at baseline, after four weeks of intervention, and at three months post-intervention to evaluate medium-term effects. Our hypothesis is that EPI will produce greater improvements in the study variables compared to DN and standard physiotherapy. Discussion: Percutaneous electrolysis has shown positive clinical effects in various musculoskeletal pathologies; however, its impact on intrafibrillar blood flow and muscle fiber elasticity remains unexplored. This study aims to provide reference clinical data on these physiological outcomes and compare the effects of invasive versus standard physiotherapy interventions, supporting the development of evidence-based protocols for whiplash-associated disorders. Clinical trial registration: NCT06938425