Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture

Abstract

Background:Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients.Methods:This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment.Results:Comparing statistically significant differences (P ≤ .001; Eta2 = 0.198–0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05).Conclusion:Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.

Kinesiophobia and Pain Intensity Are Increased by a Greater Hallux Valgus Deformity Degree- Kinesiophobia and Pain Intensity in Hallux Valgus

“…These findings were in accordance with prior studies reporting that psychological disorders were linked to musculoskeletal conditions, increasing this association with greater age distribution [8][9][10][11][12][13]. In addition, greater instability was shown in older adults under musculoskeletal disorders [14][15][16]. Finally, higher HV deformity was associated with worse physical and psychological factors [4][5][6][7]23,24].…”

“…Several psychological disorders, such as depression or sociability and vigor linked to general health-related quality of life alterations, have been associated with musculoskeletal conditions, which may increase with greater age ranges [8][9][10][11][12][13]. In addition, musculoskeletal disorders of the lower limbs may alter body stability, showing a greater instability in older adults [14][15][16]. Combining both factors, kinesiophobia and pain intensity seem to play a key role in musculoskeletal disorders prognosis [17][18][19].…”

Update on Rehabilitation Protocol Following ACL Reconstruction

“…Th e technique is proposed in the last phase of the rehabilitation program. Velázquez-Saornil et al (2016) in a randomized, single-blinded, clinical trial which included 44 subacute patients with surgical reconstruction after ACL rupture observed statistically signifi cant diff erence for both the group that received rehabilitation program and the group that received rehabilitation program associated with dry needling of the vastus medialis (eta2 coeffi cient from 0.962 to 0.980, p <0.01), for VAS and WOMAC scores, with higher scores for the dry needling group, although pain intensity was higher in the fi rst day of treatment for the dry needling group 56 .…”

Innovative Technology for High Performance and Mass Participation Sport

“…Dry needling (DN) is used to treat musculoskeletal injuries, pain, and muscle tension reduction [29][30][31]. Most of the current literature has shown the effectiveness of DN on latent trigger points [32][33][34], but there has also been success in its use to increase range of motion (ROM) after a muscle strain [35] and after an ACL reconstruction [30].…”

“…In addition to focusing on MTrPs within a muscle to release tension, there have also been studies that focus on MTrPs to increase ROM, short-term muscle endurance, and return to performance in elite athletes [45]. Most importantly, DN can help with the management of rotator cuff, as part of a conservative therapeutic intervention plan instead of surgical intervention [31]. More elite and mass sport participants may benefit from DN as health insurances in Western societies from Australia and Canada to the UK and the US increasingly cover Eastern methods of medicine, and the acceptance of formerly unique, nontraditional methods of treatment and prevention become more accepted and available to everyone in the West.…”