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Knowledge and Using of Dry Needling by Physiotherapists in Central
Africa in the Management of Trigger Points : The First Cross Sectional
Survey in Cameroon
Dilane Landry Nsangou Muntessu
(1,2) *
, Nicodemos Ngueha
(3)
, Hyacinte Trésor Ghassi
(1,2)
, Mpatoutou
Me Mpatoutou
(4)
, David Leonel Noumoe
(1)
, Philippe Caleb Perem A. Nnouka
(5)
, Franklin Chu Buh
(5)
1
Department of Physiotherapy and Physical Medicine, Faculty of Medicine and Pharmaceutical
Sciences, University of Dschang, Dschang, Cameroon
2
Faculty of Sciences and Technologies, Evangelical University Institute of Cameroon, Bandjoun,
Cameroon
3
Foyaguem Higher Institute of Dschang, Dschang, Cameroon
4
Hope Medical Clinic, Koumé-Bertoua, Cameroon
5
Department of Physiotherapy, Estuary University Institute of Bafoussam, Bafoussam,
Cameroon
6
Department of animal biology, Faculty of Sciences, University of Buea, Buea, Cameroon
*Corresponding Author
DOI:
https://dx.doi.org/10.51244/IJRSI.2025.1210000291
Received: 28 April 2025; Accepted: 04 May 2025; Published: 19 November 2025
ABSTRACT
Background: Dry Needling (DN) emerged in the 1970s as a therapeutic breakthrough, proving effective in the
treatment of Trigger Points (TP). Despite its worldwide application, there is few studies which explores
knowledge, attitudes and practices (KAP) of physiotherapists towards this technique in Central Africa,
particularly in Cameroon. This study aims to fill this gap by exploring the knowledge, attitudes and practices of
Cameroonian physiotherapists concerning DN in relation to pressure point management. Understanding their
current levels of KAP is essential to identify educational needs and developing strategies to improve TP
diagnosis, caring and DN practice in the Nation.
Methods: A quantitative and analytical cross-sectional survey was carried out online in the 10 administrative
’regions of Cameroon over a six-month period in 2023, including practicing physiotherapists with at least one
year's work experience and who had given their consent to participate to the survey. They were asked questions
about general knowledge about TP as for example diagnosis, pathophysiology and management; moreover, some
questions about general knowledge, specific attitudes and level of practice of DN in the management of TP were
added in the online questionnaire which was previously tested on a small sample of physiotherapists to ensure
good understanding and clarity of questions. Pearson correlations were performed between KAP domains
together and with sociodemographic data, Using Epi Info software version 7.2.5.0.
Results: 123 physiotherapists (PTs) out of the 300 we contacted and who were listed as practicing in Cameroon
on the official World Physiotherapy website in 2023 agreed to participate to the study, and all fulfilled inclusion
criteria. The majority were male (56.1%), with an average age of 29 ± 5 years and average year of experience of
4 ±3 years. Furthermore, 37.4 % of PTs had insufficient knowledge, and 6.5 % had poor knowledge of TP and
the various treatment methods, 14.63% had no knowledge of DN, 11.38% had very poor knowledge, 30.9% had
poor knowledge, 26.83% had good knowledge and 16.23 % had very good knowledge. Concerning attitudes, we
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51584/IJRSI | Volume XII Issue X October 2025
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noticed that 1.63% had a neutral attitude towards DN, 21.96% strongly disagreed, 18.7% disagreed, 30.09%
agreed and 27.62 % strongly agreed. With regard to respondents' DN practices, 75.61% of were not active, 7.32%
were slightly active, 16.26% were active and 0.81% were very active.
Conclusions: This study highlights a significant need for educational initiatives in the field of Trigger Point and
Dry Needling among physiotherapists in Cameroon. The results reveal a lack of knowledge and practice, despite
a positive attitude towards the technique. Addressing this need for training is essential to improving the quality
of patient care and the effectiveness of trigger zone management. The data collected provides a solid basis for
the development of targeted training programmes and resources to equip physiotherapists with the necessary
skills and knowledge. Such efforts will ultimately contribute to the advancement of physiotherapy practice in
Cameroon and Africa as a whole.
Keywords: Knowledge, attitudes, practices, Dry Needling, Cameroon, physiotherapists, and trigger point.
List of abbreviations
CASP: Cameroon Society of Physiotherapy
DN: Dry Needling
KAP: Knowledge, Attitudes and Practice
MSDs: Musculoskeletal Disorders
PTs: Physiotherapists
RCTs: Randomised Controlled Trials
TP: Trigger Point.
INTRODUCTION
Considered a genuine public health problem, musculoskeletal disorders (MSDs), one of the main causes of which
is the Trigger Point (TP), have a negative impact on people's quality of life and socio-professional fulfilment (1).
It affects around 1.71 billion people, i.e. 22% of the world's population (2). Studies in some African countries
and in Cameroon show a prevalence of MSDs in excess of 50%, with preferential regions being the lumbar and
cervical spine, hip, knee and wrist (3, 4). A myofascial TP is a sensitive spot in a palpable taut band of skeletal
muscle fibers. Two important clinical characteristics of it, referred pain and local twitch response can be elicited
by mechanical stimulation (palpation or needling). A TP is usually activated by acute or chronic injury to a
muscle, tendon, ligament, joint, disc or nerve. Recently, human and animal studies suggested that the
pathogenesis of either referred pain or local twitch response is related to integration in the spinal cord. It has
been proposed that there are multitude sensitive loci in a trigger point region. A sensitive locus may contain one
or more sensitized nociceptive nerve endings. Theoretically, sensitive loci can be found in any side of a skeletal
muscle, but is usually distributed with highest concentration near the endplate region where a TP is frequently
found (5). In recent years, therapeutic advances have led to Dry Needling (DN), which emerged in the 70s as a
proven therapy for the treatment of TP to resolve this health problem. Its use by physiotherapists in developed
countries is around 30% globally and specifically, we have: 25% in Australia, 15.7% in France and 26.8% in
China; In South Africa, 75% of physiotherapists use it at least once a day (6). A number of studies have evaluated
the risks of the practice for doctors and physiotherapists, and have all concluded that it is safe (7). Furthermore,
the diagnosis of TP as a cause of MSDs was rarely discussed, and the practice of DN as a therapy for TP was
not mentioned. However, over the past few years, evidence-based studies have been published with considerable
scientific proof of the relevance of DN for the treatment of MSDs, and physiotherapists seem to be using it more
and more in their practices. (6,7,8,9). Browsing on PubMed, PEDro, Cochrane Library and Google Scholar,
studies with high levels of evidence on DN and TP were found, including studies made by: Dommerholt et al.
2006 (6), Gattie et al. 2017(8), Lew et al. 2020 (9), and Navarro et al. 2020 (10). Hence the need to investigate
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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the practice of this technique in Central Africa in general, and Cameroon specifically where evidence-based
practice is poorly taught and used by PTs and the diagnostic methods for TP are often misunderstood. The aim
of this study was to highlight the level of knowledge and practice of physiotherapists with regard to DN, as well
as their attitudes towards this technique in the management of TP.
METHODS
Study design: we conducted a quantitative-analytical online cross-sectional survey during 6 months, from
January 10 to June 10, 2023 among PTs throughout the 10 administrative ‘regions of Cameroon through a
questionnaire that was specifically designed for the study and was pretested. The questionnaire contained 25
questions divided into 4 sections, with a completion time of approximately 10 minutes, in French and English.
Cameroon is a Central African country located at the bottom of the Gulf of Guinea, between the 2nd and 13th
degrees North latitude and the 9th and 16th degrees East longitude, with an estimated population of 28,647,293
in 2023. (11, 12)
Study participants: Physiotherapists present and practicing in the 10 regions of Cameroon with at least 1 year's
work experience and who had given their consent during the phone calls exchange were included in the study.
Sampling: We used non-probability snowball sampling, as we did not have a precise sampling frame at the
outset, although the expected sample size was estimated at 250 physiotherapists based on world physiotherapy
data in 2022 (13). Participants were recruited online, via social networks (WhatsApp groups) or by e-mail and
phone’ call.
Data collection tool: This study used an electronic questionnaire consisting of a header note and 34 questions
distributed as follows: Nine (09) questions for socio-demographic data; Twelve (12) questions for knowledge,
i.e. 05 questions for knowledge of TP and the various treatment methods and 07 questions for knowledge of DN;
Nine (09) questions for DN practices and four (04) questions for attitudes to DN. Notations were made during
the analysis (1 point for each correct proposition and 0 for each false proposition) and a total score was obtained
for knowledge of TP (score/5) and DN (score/9), attitudes (score/18) and practices (score/22). At the end,
mentions were attributed to these different scores as follows: Poor (less than 25% of the total score); Insufficient
(between 25 and 50% of the total score); Good (between 50 and 75% of the total score) and Very Good (more
than 75% of the total score).
Data collection techniques: After obtaining administrative authorizations and consulting the national ethics
committee for human health research, the questionnaire was pre-tested and put online in Google format in French
and English, then the links were shared on several platforms: On social networks via platforms dedicated to the
Physiotherapists of the Nation, in the form of an electronic message to physiotherapists individually, so that we
contacted 300 eligible participants.
Data analysis: Epi Info software version 7.2.5.0 was used, and data were expressed as percentages. Linear
regression was used to establish the degrees of association between the dependent and independent variables,
which were defined using Pearson's correlation coefficient followed by the P value. Associations were said to
be significant for P˂0.05 and r-values between one and one. These results were presented in tables and figures
produced using Microsoft (Word and Excel) 2016 software. The Vancouver model was used for bibliographic
references.
Ethical consideration: the confidentiality and anonymity of respondents were respected in accordance with the
principles of medical ethics and deontology.
RESULTS
Socio-demographic characteristics of respondents: 123 physiotherapists took part in the study out of the 240
contacted, giving an overall response rate of 51.25%. The study revealed that 56.1% (69) of participants were
male and 43.9% (54) were female, giving a sex ratio (M/F) of 1.07. The average age of respondents was 29 ± 5
years, with extremes of 21 and 50 years. The most represented age group was [26 - 31[or 33.33% followed by
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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[21 - 26[or 32.52% and the least represented were [41 - 46[and [46 - 51[or 0.81% each. The average year of
experience of respondents was 4 ± 3 years, with extremes of 1 and 15 years. The most common year of experience
was [1 - 3 [or 44.72%. Physiotherapists practicing in the West, Centre and Littoral regions were the most
represented, at 29.25%, 28.45% and 21.14% respectively; the North, South and Adamaoua regions were the least
represented, at 0.81% each. By level of study, physiotherapists with a Bachelor's degree were the most
represented, at 51%, followed by those with a BTS or TPMS diploma, at 34%, those with a Master's degree, at
14%, and those with a PhD diploma, at 1%. Most physiotherapists (36%) worked in hospitals, 34% in private
practice and 30% in both regimes. The average year of graduation was 2019 ± 3 years, with extremes of 2008
and 2023. The most represented year of graduation was [2020 - 2024 [or 44.72%. Concerning the place of
training, 93.5% were trained in Cameroon and 6.5% abroad. The majority of physiotherapists (86.99%) had
attended at least one seminar, while 13.01% had never attended a seminar. (Table 1)
Respondents' knowledge of triggers points and dry needling: Of the 123 physiotherapists questioned, the
majority (37.40%) had insufficient knowledge, 30.08% had very good knowledge, 26.02% had good knowledge
and 6.50% had poor knowledge of TP and the various treatment methods. Furthermore, 14.63% had no
knowledge of DN, 11.38% had poor knowledge, 30.9% had poor knowledge, 26.83% had good knowledge and
16.23 % had very good knowledge.
Respondents' attitudes and practices towards Dry Needling: Of the 123 physiotherapists surveyed, 1.63%
had a neutral attitude towards DN, 21.96% strongly disagreed, 18.7% disagreed, 30.09% agreed and 27.622%
strongly agreed. With regard to respondents' DN practices, 75.61% of respondents were not active, 7.32% were
slightly active, 16.26% were active and 0.81% were very active. (Table 2)
Correlation between KAP and sociodemographic characteristic: We found that there was no linear
relationship between level of education and: knowledge of PT (r=0.03, P=0.05); knowledge of Dry Needling
(r=0, P=0.7); practice of Dry Needling (r=0.05, P=0.01); attitude to Dry Needling (r=0, P=0.8). (Table 3)
Table 3: Correlation between socio-demographic data and participants' knowledge, attitudes and practices
Socio-demographic
data
TP knowledge
Knowledge of
DN
Practices of the
DN
Level of study
r = 0,03
P = 0,0553
r = 0
P = 0,7242
r = 0,05
P = 0,0139
Year of experience
r = 0
P = 0,5542
r = 0,07
P = 0,0041
r = 0,21
P < 0,0001
Year of graduation
r = 0
P = 0,9370
r = 0,05 P =
0,0137
r = 0,19 P <
0,0001
Number of seminars
held
r = 0,05 P =
0,0158
r = 0,09 P =
0,0009
r = 0,13 P <
0,0001
Correlation between Knowledge, attitude and practice: we found that physiotherapists' knowledge of Dry
Needling seemed to encourage its use (practice) in patient management (r=0.43, P < 0,0001). Similarly, the
increase in knowledge about this technique seemed to encourage good attitudes (r = 0,15 P < 0,0001). (Table 4)
Tableau 4: Correlation between attitudes, knowledge and practice among participants
Practices of the DN
Attitudes towards DN
TP knowledge
r = 0
P = 0,4410
r = 0,03 P = 0,0568
Knowledge of DN
r = 0,43 P < 0,0001
r = 0,15 P < 0,0001
Attitudes towards DN
r = 0,12 P < 0,0001
TP: Trigger Point; DN: Dry Needling.
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DISCUSSION
This study is the first in Cameroon, to attempt to explore the knowledge, attitudes and practices of
physiotherapists regarding the DN technique used to treat TP. A total of 123 physiotherapists practicing in the
country's 10 regions, with the West region predominating, took part in the study, with a participation rate of
51.25%. Most respondents were male (56.1%) with an average age of 29 ± 5 years. The median year of
graduation was 2021, and the majority (36%) worked in a hospital. The gender distribution in this sample seems
contradictory to the national distribution for 2022 published by the WP, in which 80% of physiotherapists
nationwide would be female (13). This difference could be explained by the fact that men were more hostile to
participating in the study than women when we contacted them. The dominance of physiotherapists practicing
in the western region could be because the main investigator lived in the region, which would have favoured
interaction between him and the region's physiotherapists. In addition, 86.99% of respondents had already taken
part in at least one seminar in Physiotherapy. They had an average of 4 ± 3 years’ experience, with a Bachelor's
degree (35%). This could be explained by the fact that the profession in general is less established in Cameroon,
in other words, new, and that the cost of training is very high, thus reducing the need for further study.
Concerning physiotherapists' knowledge of TP and DN techniques, the results of the study show that 37.40% of
physiotherapists have insufficient knowledge of TP and 30.90% of physiotherapists have insufficient knowledge
of DN. These results could be explained by the fact that, although TP is one of the main causes of MDS and the
primary reason for health consultations, physiotherapists focus more on pain symptoms than on the TP (14). In
addition, training programs for physiotherapists in Cameroon do not emphasize TP and the DN technique in the
module on musculoskeletal rehabilitation.
With regard to physiotherapists' attitudes towards DN, most (64.23%) suggested that it should be added to
training programs for physiotherapists in Cameroon, and that practical seminars and workshops should be
organized to retrain physiotherapists already in practice. Considering attitude scores, physiotherapists gave great
importance to the DN technique (9.94 ± 5.05 out of 18) with 30.09% having good attitudes towards DN. These
results could be explained by the fact that, despite their insufficient knowledge, they nevertheless have a
penchant for this practice, which is still new in Cameroon. Furthermore, there were positive correlations between
socio-demographic data (year of experience, year of highest diploma, number of seminars attended) and their
attitudes.
Taking into account the practice scores, it emerges that physiotherapists do not attach great importance to DN
practice (3.08 ± 5.55 out of 22), i.e. a practice rate of 24.39%. These results may be justified by the fact that DN
is less well known in Cameroon and is not an integral part of the physiotherapist's training program. These results
are similar to those obtained in Australia (25%) and China (26.8%), and much lower than those obtained in South
Africa (75%) in 2006 (6). Although the rate of DN practice is similar to that in other countries, we note a long
delay in the implementation of this technique in Cameroon. This could be explained by the fact that DN is not
legalized in Cameroon as a therapeutic means in physiotherapy. In addition, there was a positive correlation
between the number of seminars attended and practice, which could be explained by the fact that physiotherapists
practicing DN would have learned at a seminar. Similarly, there was a correlation between knowledge of DN,
attitudes towards DN and practice. This could be explained simply by the fact that a good knowledge of a
problem will lead to a good perception of it, and in the same way to good practice.
LIMITS OF THE STUDY
Online participation: The online method may have excluded potential participants who do not have access to
the internet or who are not comfortable with digital technologies, which could affect the representativeness of
the results.
Selection bias: Physiotherapists who chose to participate may have different levels of knowledge, attitudes and
practices to those who did not, which could introduce a selection bias.
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Self-reporting: The data collected relies on self-reported responses from participants, which may introduce
response bias or inaccuracies due to recall errors or social desirability.
Regional diversity: Although the study was conducted in all 10 regions of Cameroon, regional differences in
access to training and resources may not be fully captured by the study.
Limited sample: A sample of 123 participants, while large, may not be sufficient to generalise the results to all
physiotherapists in Cameroon or other Central African countries.
CONCLUSION
The present study was conducted to explore the knowledge, attitudes and practices of physiotherapists in
Cameroon regarding the DN technique used to treat TP. It revealed that 33.90% and 56.91% of physiotherapists
had inadequate knowledge of TP and DN respectively. The main needs concerned diagnostic tools and the
different types of TP, other names given to DN and the method of practicing DN. On the other hand, 42.29% of
physiotherapists had inappropriate attitudes to DN, and 24.39% used DN sometimes alone or in combination
with other therapeutic means, for multiple reasons, with results ranging in most cases from effective to very
effective. Generally speaking, these data show that physiotherapists have little knowledge of TP and DN and a
low level of practice, but nevertheless have positive attitudes, hence the need to conduct investigation and
training campaigns among them. However, it would be important in our context to conduct Randomized
Controlled Trials (RCTs) to effectively qualify the efficacy of DN and our usual techniques.
Recommendations
We propose that accredited physiotherapy associations in Cameroon organise training sessions and seminars on
trigger point management using recent advances, including the use of dry needling. We also suggest that
academic institutions include this technique in the training programme for the nation's future physiotherapists.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical
approval was obtained from West Regional ethics committee for human health research. All participants
provided informed consent before entering the study. Information about the study objectives, procedures and
participants' rights was clearly communicated, and participants were given the opportunity to withdraw their
consent at any time without consequence.
Consent for publication
Not applicable.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on
reasonable request.
Competing interests
The authors declare that they have no competing interests.
Funding
We did not receive funding for this study.
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Authors’ contributions
DLNM designed the study project, drew up the questionnaire and supervised the conduct of each stage of the
study and the drafting of the manuscript. NN contacted all study participants to obtain their informed consent
and participation, and contributed to the drafting of the manuscript. HTG edited the manuscript and contributed
to the interpretation of the data. MMM contributed to the drafting of the manuscript and the interpretation of the
results. PCPA and FCB supervised the correction of the manuscript.
ACKNOWLEDGMENT
We would like to thank the CASP and its former president, PT Thierry, for their involvement in putting us in
contact with physiotherapists in the different regions of the country. We would also like to express our sincere
thanks to all the participants in the study, without whom we would not have obtained our results.
Tables
Table 1: Sociodemographic data
Sociodemographic data
Option
Staff (%)N =
123
Gender
Male
69(56)
Female
54(44)
Age
[21 - 26[
40(32.52)
[26 - 31[
41(33.33)
[31 - 36[
20(16.26)
[36 - 41[
20(16.26)
[41 - 46[
1(0.81)
[46 - 51[
1(0.81)
Year of experience
[1 - 3[
55(44.72)
[3 – 5[
17(13.82)
[5 – 7[
16(13.01)
[7 – 9[
15(12.20)
[9 – 11[
12(9.76)
[11 – 13[
3(2.44)
[13 – 15[
4(3.25)
[15 – 17[
1(0.81)
Place (region) of exercise
West
36(29.25)
North west
6(4.88)
East
2(1.63)
South west
12(9.77)
Littoral
26(21.14)
North
1(0.81)
South
1(0.81)
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Extreme-north
3(2.44)
Adamaoua
1(0.81)
Center
35(28.45)
Level of study
Bachelor
63(51)
Phd
1(1)
Master
17(14)
Hnd/tms
41(34)
Exercise regime
In hospital
44(36)
The two
37(30)
Liberal
42(34)
Place of formation
Abroad
08(6.5)
In cameroon
115(93.5)
Year of obtaining the last diploma (in relation to
physiotherapy)
[2008 – 2012[
4(3.25)
[2012 – 2016[
20(16.26)
[2016 – 2020[
23(18.70)
[2020 – 2024[
76(61.79)
Number of seminars participate to date
No one
16(13.01)
One
5(4.07)
Two
20(16.26)
Three
14(11.38)
Four
13(10.57)
Five
13(10.57)
Between six and
ten
17(13.82)
More than ten
25(20.33)
Table 2: knowledge, attitudes and practices of DN and TP
CAP
Mention
Score
Staff (%)N = 123
Knowledge of TP
Weak
2
8(6.50)
Insufficient
3
46(37.40)
Good
4
32(26.02)
Very Good
5
37(30.08)
Knowledge of DN
No knowledge
0
18(14.63)
Low
1
8(6.50)
2
6(4.88)
Insufficient
3
19(15.45)
4
19(15.45)
Good
5
15(12.20)
6
18(14.63)
Very Good
7
12(9.76)
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8
4(3.25)
9
4(3.25)
Attitude
Neutral
0
2(1.63)
Weak
2
2(1.63)
3
23(18.70)
4
2(1.63)
Insufficient
5
3(2.44)
6
4(3.25)
7
5(4.07)
8
4(3.25)
9
7(5.69)
Good
10
6(4.88)
11
10(8.13)
12
9(7.32)
13
12(9.76)
Very Good
14
8(6.50)
15
6(4.88)
16
10(8.13)
17
4(3.25)
18
6(4.88)
Practice
Inactive
0
93(75.61)
Slightly active
9
1(0.81)
10
3(2.44)
11
5(4.07)
Active
12
8(6.50)
13
2(1.63)
14
5(4.07)
15
4(3.25)
16
1(0.81)
Very active
18
1(0.81)
TP: Trigger Point
DN: Dry Needling
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