THE EFFECTS OF TREATMENT COMBINED DRY NEEDLING AND LIGHT THERAPY (MEDOLIGHT) IN THE MANAGEMENT OF MYOFASCIAL UPPER BACK PAIN SYNDROME IN SOCCER PLAYERS

Introduction The active presence of the physiotherapist is essential within the multidisciplinary sports team, taking into account the complexity of sports injuries and the whole set of circumstances that determine them [6]. Sports injuries can vary depending on the severity criterion: from mild variants that only describe the presence of pain as a clinical symptom and do not require the acute intervention of medical personnel, to serious injuries that can prevent the athlete from participating in sports activities, with unfavorable consequences on sports performance in the future. Modern therapeutic approaches suggest the importance of constant assessment in accordance with the bio-psycho-social model according to the psycho-emotional factors and the level of motivation that can lead a patient to be more or less compliant with treatment. At the same time, it is necessary to systematically analyze all the characteristics of the subjects involving age, sport discipline practiced, performance level and other details specific to sports biomechanics. These particularities can facilitate the creation of a profile of the sports patient. Myofascial pain syndrome represents an extremely frequent therapeutic situation in the daily work of every physiotherapist. Regardless of their location or the way of manifestation, the presence of trigger points in the structure of muscle fibers describes a series of clinical dysfunctions that can affect the quality of life of the subjects. This syndrome is generally characterized by two forms of manifestation, depending on the development and type of trigger points: active and latent. Active trigger points are locally identified as hyperirritant points in a palpable, taut band of muscle that cause characteristic spontaneous pain on palpation [8]. Latent trigger points share the same physical characteristics as the active variants, but are generally located in muscles that are painless and require palpation to elicit symptoms [21]. Specialized studies have identified a significant volume of factors that lead to the development of trigger points, such as: accidents/injuries, postural stress, endocrine disorders, psychosocial stressors, insufficient physical activity, sleep disorders [17]. Mechanisms of production may still warrant further investigation, but clinical manifestations include local and/or remote/radiating pain (depending on the reference area), motor dysfunction, limited range of motion, and decreased muscle strength [9]. The systematic analysis of myofascial pain syndrome places this pathology in a category without a potential volume of risk factors that severely affect the health of athletes, such as muscle injuries or other types of trauma to the osteo-articular system. However, there are studies that demonstrate and analyze the consequences of inadequate or late management of myofascial pain syndrome, regardless of the segment involved and including athletes [11] [18]. The literature identifies a multitude of therapeutic approaches for the management of upper back pain. In contrast, the number of studies expressing the role of a combination protocol for upper back myofascial pain syndrome in athletes is limited. Dry needling (DN) therapy is a modern treatment performed by means of a dry, fine and short needle that is most frequently inserted deep into trigger points or in their vicinity [14]. Multiple studies have analyzed the impact of dry needling therapy on myofascial pain syndrome, muscle pain or in therapeutic situations that described a limitation of functionality (mobility, flexibility, muscle strength) (Table 1). In most of the situations the final results were compared with those of the control groups that benefited from manual therapies and/or therapeutic physical exercises