Table 1 Dry needling protocol for plantar heel pain, developed by consenus

Setting

Treatment will be conducted in the La Trobe University Health Sciences Clinic, Bundoora, Melbourne, Australia.

Consultation

Treatment will be conducted within a 30-minute timeframe. The participant will be lying down.

Rationale

Myofascial trigger point model.

Dry needling details

1.

Brand of acupuncture needle: Seirin™ J-Type or Hwa-To™ Ultraclean.

2.

Muscles to be dry needled. Muscles to be assessed first will include those harbouring myofascial trigger points that might be responsible for the participant's pain including the Sol, QP, FDB and Abd H muscles. Synergists and antagonists of these muscles will also be assessed for MTrPs. These muscles will include the Gastroc, FDL, FHL, PL, PB, TA, EHL, EDL, Add H, Abd Dig Min, Lb and Int. In addition a search will be undertaken for MTrPs in muscles which might be influencing the participant's loading of the aforementioned muscles. These muscles will include the Pf, G Max, G Med, G Min, TFL, AL, AM, AB, ST, SM and BF.

3.

Needle length and diameter. Needle length will be determined by the location of the MTrP to be dry needled. Most commonly the needle length will range from 30 to 75 mm. The diameter of the needle will be 0.30 mm but will be varied depending on the participant's tolerance to insertion of the needle. A smaller diameter needle may be used if needle insertion is uncomfortable.

4.

Needle insertions per muscle. The number of needle insertions per muscle will depend on: the number of MTrPs to be dry needled; participant's tolerance to needle insertion; responsiveness of the tissue to dry needling; and level of post needle soreness for a specific muscle. Most commonly the number of needle insertions will range from 1-5.

5.

Response elicited. Dry needling of a MTrP will attempt to elicit an appropriate response such as a: local twitch response (LTR); sensation such as a dull ache, heaviness, distension, pressure or bruising; and/or a reproduction of the participant's symptoms. If an appropriate response is not elicited the needle will be removed and the participant re-examined.

6.

Manipulation of the acupuncture needle. Following insertion, the acupuncture needle will be withdrawn partially and advanced repeatedly to produce an appropriate response. If the participant is sensitive to insertion of the needle the manipulation will be reduced. If this action is insufficient to reduce the painful stimulus, the manipulation will be ceased and the needle left in situ. Alternatively, the needle may be replaced with a needle that has a smaller diameter.

7.

Needle retention time. The needle will remain in the muscle for as long as it takes to produce an appropriate response and is tolerated by the participant. Once this has occurred the needle will be left in situ for 5 minutes. This will allow sufficient time for the stimulus to subside in participants that are sensitive to the treatment.

Treatment regimen

The clinical trial will involve 1 treatment per week for 6 weeks. Treatment will be ceased if a participant's symptoms resolve prior to the course of the dry needling treatment. However, if a participant experiences a relapse within the 6 week treatment period they will be offered further weekly treatment (s) until the end of the 6 week course.