Effectiveness of Inclusion of Dry Needling in a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial

Abstract

Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions that include exercise therapy may be effective for patellofemoral pain (PFP); however, no study has investigated the effects of trigger point (TrP) dry needling (DN) in people with PFP. Objectives To compare the effects of adding TrP DN to a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n = 60) recruited from a public hospital in Valencia, Spain were randomly allocated to manual therapy and exercises (n = 30) or manual therapy and exercise plus TrP DN (n = 30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks), and 1 group also received TrP DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS; 0–100 scale) was used as the primary outcome. Secondary outcomes included other subscales of the KOOS, the Knee Society Score, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and the numeric pain-rating scale. Patients were assessed at baseline and at 15-day (posttreatment) and 3-month follow-ups. Analysis was conducted with mixed analyses of covariance, adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-group differences (all, P>.391) were observed for any outcome: KOOS pain subscale mean difference, −2.1 (95% confidence interval [CI]: −4.6, 0.4); IKDC mean difference, 2.3 (95% CI: −0.1, 4.7); knee pain intensity mean difference, 0.3 (95% CI: −0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (standardized mean differences of 0.6 to 1.1); however, only the KOOS function in sport and recreation subscale surpassed the prespecified minimum important change. Conclusion The current clinical trial suggests that the inclusion of 3 sessions of TrP DN in a manual therapy and exercise program did not result in improved outcomes for pain and disability in individuals with PFP at 3-month follow-up. Level of Evidence Therapy, level 1b. Prospectively registered July 27, 2015 at www.clinicaltrials.gov (NCT02514005). J Orthop Sports Phys Ther 2017;47(6):392–401. doi:10.2519/jospt.2017.7389

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

“…A new high-quality RCT evaluating dry needling to trigger points27 was identified in the 2017 update. While the expert panel acknowledged that acupuncture and trigger point dry needling have key differences in their clinical indication and application, it was decided to group them in a single recommendation on the basis that evidence for both was limited and uncertain.…”

Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial

“…Deep dry needling (DDN) is a minimally invasive therapy frequently included in the treatment of multiple pain conditions. Previous research has investigated its effectiveness in patients presenting with disorders such as nonspecific low back [1], neck, or shoulder pain [2]; lateral epicondylalgia [3]; temporomandibular disorders [4]; plantar heel pain [5]; or patellofemoral pain [6]. A recent meta‐analysis has concluded that very low‐to‐moderate evidence supports its effectiveness against no treatment or placebo improving pain in the short and medium term [7].…”

Changes in Knee Vastii Muscle Activity in Women with Patellofemoral Pain Syndrome During the Menstrual Cycle

“…The exclusion criteria were history of fracture, dislocation, or surgery in the lower extremity or trunk regions; any self‐reported history and clinical evidence of recent ligament sprain, meniscal defect, chondral lesion, or disease of the patellar tendon; osteoarthritis; history or clinical evidence of low back pain or sacroiliac joint dysfunction during the previous 6 months; disk herniation or referred spinal pain; any other disorders such as neurologic disorders that might interfere with the kinematics or kinetics of trunk, hip, knee and ankle motion; and participation in professional athletic activities. In addition, any systemic disease that could affect our results, for example, cardiovascular, metabolic or respiratory disease, pregnancy, or breastfeeding (current or within the preceding year), implantable or injectable contraceptive use, and premenstrual syndrome (Appendix 3) were considered exclusion criteria.…”