Application of trigger point dry needling can induce post-dry needling soreness. This is not a negative experience, but sometimes some patients want to reduce it as much as possible. Different therapeutic strategies targeting to decrease post-dry needling soreness need to be investigated. Previous studies have investigated spray and stretch, ischemic compression or low-load eccentric exercise as post-needling intervention procedures. There is increasing evidence supporting the role of descending pain inhibition mechanisms for paon control. The application of virtual reality as a distraction technique could active brain mechanisms during dry needling. Therefore, the objective of this study will be to investigate the effects of playing virtual reality during the application of dry needling on post-needling soreness over trigger points in the extensor carpi radialis brevis muscle. A secondary aim will be to determine the prognostic role of baseline scores of pressure pain sensitivity, related-disability, anxiety and catastrophizing levels.

Inclusion Criteria for pain-free participants:

• no history of upper quadrant pain symptoms the year preceding the study
• no history of upper quadrant surgery
• presence of a latent trigger point in the extensor carpi radialis brevis muscle

Inclusion criteria for patients with elbow pain:

• pain over the lateral side of the elbow;
• pain on palpation over the lateral epicondyle or the associated common wrist extensor tendon;
• elbow pain with either resisted static contraction or stretching of the wrist extensor muscles.
• presence of an active trigger point in the extensor carpi radialis brevis muscle

Exclusion Criteria:

• bilateral symptoms;
• older than 50 years of age;
• previous surgery or steroid injections;
• other diagnoses of upper extremity (shoulder pathology, cervical radiculopathy, cervical whiplash);
• history of cervical or upper extremity trauma;
• history of musculoskeletal medical conditions (rheumatoid arthritis, fibromyalgia);