Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial

Abstract

Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis

“…After the full review process, 12 studies were selected for inclusion. 2,7,12,24,27,28,32,33,35,36,38,43 After contact with primary authors of included studies, 1 further study was identified for inclusion, 6 resulting in a total of 13 studies. The absolute degree of rater agreement for the first and second stages of the study selection was 86% and 93%, respectively.…”

“…This systematic review focused on musculoskeletal pain and included 13 studies: 6 on neck pain (5 on mechanical neck pain 6,24,28,32,43 and 1 on chronic whiplash-associated disorder 38 ), 1 on postoperative shoulder pain, 2 1 on chronic lower back pain, 33 1 on total knee arthroplasty, 27 1 on chronic ankle instability, 35 2 on myofascial pain, 12,36 and 1 on fibromyalgia. 7 Inclusion and exclusion criteria varied greatly across the studies.…”

Spinal and Peripheral Dry Needling Versus Peripheral Dry Needling Alone Among Individuals With a History of Lateral Ankle Sprain: A Randomized Controlled Trial

“…Study participants were seated on a treatment table during the hand dynamometry and no and scores on the Functional Ankle Ability Measure (FAAM) compared to proprioceptive exercises alone. 5 These participants received four needling interventions as compared to the single treatment provided in this study, so it is possible that multiple needling treatments are needed to gain enough improvement to be reflected in a functional assessment tool.…”

“…Previous investigators have shown abnormalities of the fibularis muscles in persons with CAI, including reduced reaction time, diminished postural control and corticomotor excitability, and the presence of myofascial trigger points (MTrPs). 5,6,7 MTrPs are areas of increased irritability in palpable taut bands of skeletal muscle tissue that are clinically associated with both local and referred pain, muscle dysfunction, and autonomic phenomena. [8][9][10] In addition to other intervention strategies, the use of dry needling as a treatment for MTrPs is gaining attention as investigations on its effectiveness emerge.…”

“…25,26 With regard to chronic ankle instability, a randomized clinical trial compared the effects of combined MTrP dry needling of the fibularis muscle and therapeutic exercises to therapeutic exercises alone for pain and function in subjects with chronic ankle instability. 5 The authors concluded that subjects who received the combined therapy approach demonstrated superior outcomes in pain and function one month after ceasing treatment.…”