Participants assigned to the intervention group received the physical therapy treatment described above, as well as dry needling of active MTrPs identified by the treating physical therapists in the participants’ supraspinatus, infraspinatus, subscapularis (medial, lateral superior, and lateral inferior), teres minor, and deltoid (anterior, medial, and posterior) muscles. Needling was performed using the Hong technique31 (“fast in, fast out”), accompanied by the subsequent application of cold spray to diminish any pain sensation after needling.44,64 Acupuncture needles measuring 0.25 × 25 mm, 0.30 × 50 mm, and 0.30 × 75 mm, with a guide tube, were used. A total of 3 needling sessions were conducted, distributed over the first, fourth, and seventh sessions, respectively, in order to have 8 days between each dry needling17 and needling of the active MTrPs once in each session