Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial

Abstract

Study DesignRandomized, single-blinded, multi-center, parallel-group trial.ObjectivesTo compare the effects of adding electrical dry needling into a program of manual therapy, exercise and ultrasound on pain, function and related-disability in individuals with plantar fasciitis (PF).BackgroundThe isolated application of electrical dry needling, manual therapy, exercise, and ultrasound has been found to be effective for PF. However, no previous study has investigated the combined effect of these interventions in this population.MethodsOne hundred and eleven participants (n = 111) with plantar fasciitis were randomized to receive electrical dry needling, manual therapy, exercise and ultrasound (n = 58) or manual therapy, exercise and ultrasound (n = 53). The primary outcome was first-step pain in the morning as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included resting foot pain (NPRS), pain during activity (NPRS), the Lower Extremity Functional Scale (LEFS), the Foot Functional Index (FFI), medication intake, and the Global Rating of Change (GROC). The treatment period was 4 weeks with follow-up assessments at 1 week, 4 weeks, and 3 months after the first treatment session. Both groups received 6 sessions of impairment-based manual therapy directed to the lower limb, self-stretching of the plantar fascia and the Achilles tendon, strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound. In addition, the dry needling group also received 6 sessions of electrical dry needling using a standardized 8-point protocol for 20 minutes. The primary aim was examined with a 2-way mixed-model analysis of covariance (ANCOVA) with treatment group as the between-subjects variable and time as the within-subjects variable after adjusting for baseline outcomes.ResultsThe 2X4 ANCOVA revealed that individuals with PF who received electrical dry needling, manual therapy, exercise and ultrasound experienced significantly greater improvements in first-step morning pain (F = 22.021; P<0.001), resting foot pain (F = 23.931; P<0.001), pain during activity (F = 7.629; P = 0.007), LEFS (F = 13.081; P<0.001), FFI Pain Subscale (F = 13.547; P<0.001), FFI Disability Subscale (F = 8.746; P = 0.004), and FFI Total Score (F = 10.65; P<0.001) than those who received manual therapy, exercise and ultrasound at 3 months. No differences in FFI Activity Limitation Subscale (F = 2.687; P = 0.104) were observed. Significantly (X2 = 9.512; P = 0.023) more patients in the electrical dry needling group completely stopped taking medication for their pain compared to the manual therapy, exercise and ultrasound group at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2 = 45.582; P<0.001) more patients within the electrical dry needling group (n = 45, 78%) achieved a successful outcome compared to the manual therapy, exercise and ultrasound group (n = 11, 21%). Effect sizes ranged from medium to large (0.53<SMD<0.85) at 3 months in favor of the electrical dry needling group.Conclusi...

Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial

“…The dry needling technique is often non-standardized and may include adjunct treatments, such as electrotherapy. The joint application of DN and electrotherapy has been given numerous names, including electroacupuncture [17], intramuscular electrical stimulation [18], or electrical dry needling [19]. These electric stimulation techniques include the passage of an electrical current through the needle [20].…”

“…One of the most utilized techniques to treat MTrPs is percutaneous electrical nerve stimulation (PENS) [20]. PENS is the application of a low-intensity current through an acupuncture needle [19,21]. Although the neuroplasticity processes involved in its effect are not yet well understood, it is a technique of electroacupuncture used to modulate pain processing in some chronic pain conditions, such as myofascial pain syndromes and chronic tensional headache [22,23].…”

“…PENS application to MTrPs would stimulate muscle nociceptors, which activates the endogenous antinociceptive system [ 21 , 26 ]. Several forms of application have been described depending on where the needles are inserted [ 19 , 20 , 27 ].…”

Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial

“…Following baseline examination, patients were randomly assigned to receive spinal manipulation and dry needling or spinal mobilization and exercise. Similar to our previous trials, [14,41,42] concealed allocation was conducted using a computer-generated randomized table of numbers created by a statistician who was not otherwise involved in…”

The impact of shock wave therapy on reducing pain in patients with heel spurs

“…Development of calcaneal spur in such circumstances is a defense mechanism. Continuous irritation of the surrounding structures by pressure results in chronic inflammation of the heel bone area and enthesopathy of plantar fasciitis at its attachment to heel bone tuberosity [10,13]. Ca.…”