ORIGINAL PAPER
Effects of trigger point dry needling on pain, strength, and functional status among patients with anterior knee pain: a randomised controlled trial
1
Irshad Memorial Hospital, Islamabad, Pakistan
2
Memon College of Physical and Rehabilitative Medicine, Karachi, Pakistan
3
Department of Physical Therapy, Abasyn University, Islamabad, Pakistan
4
Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
5
Isra Institute Rehabilitation Sciences, Islamabad, Pakistan
Submission date: 2024-07-04
Acceptance date: 2024-12-16
Online publication date: 2025-11-28
Corresponding author
Nazish Rafique
Memon College of Physical and Rehabilitative Medicine, Circulation Road, Gulzar-e-Hijri Scheme 33, Karachi, Pakistan
Memon College of Physical and Rehabilitative Medicine, Circulation Road, Gulzar-e-Hijri Scheme 33, Karachi, Pakistan
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The objective of this study was to assess the effects of trigger point dry needling on pain, strength, and functional status among patients with anterior knee pain.
Methods:
This randomised controlled trial was conducted in the physical therapy department, Memon Medical Institute Hospital. Thirty patients, both male and female, between the ages of 20–45 years, participated. They were randomly divided into two groups through the sealed envelope method. Stretching and strengthening exercises were given to both groups; moreover, the experimental group underwent dry needling. The primary outcomes were pain intensity, knee range of motion, and muscle strength measured by the Numeric Pain Rating Scale (NPRS), goniometry, and manual muscle testing. The secondary outcomes were disability measured by the Kujala score and the Lower Extremity Functional Scale (LEFS). The assessment was done at baseline and after the second and fourth weeks. The Shapiro–Wilk test determined the normality, and the Mann–Whitney and an independent sample t-test were used to compare the variables.
Results:
The average age of participants was 33.8 years, and the study includes 46.7% males and 53.3% females. The Mann–Whitney and an independent sample t-test showed that every participant in the experimental group experienced a significant improvement in their functional status, muscle strength, pain, and knee ranges (p < 0.05). No significant differences were reported for the range of motion of left knee flexion, or strength of the left quadriceps muscles (p > 0.05).
Conclusions:
This randomised controlled trial shows that both techniques are effective for the treatment of anterior knee pain; however, the dry needling technique is a clinically more effective treatment approach to decreasing pain and improving muscle strength, knee ranges and functional status in patients.
The objective of this study was to assess the effects of trigger point dry needling on pain, strength, and functional status among patients with anterior knee pain.
Methods:
This randomised controlled trial was conducted in the physical therapy department, Memon Medical Institute Hospital. Thirty patients, both male and female, between the ages of 20–45 years, participated. They were randomly divided into two groups through the sealed envelope method. Stretching and strengthening exercises were given to both groups; moreover, the experimental group underwent dry needling. The primary outcomes were pain intensity, knee range of motion, and muscle strength measured by the Numeric Pain Rating Scale (NPRS), goniometry, and manual muscle testing. The secondary outcomes were disability measured by the Kujala score and the Lower Extremity Functional Scale (LEFS). The assessment was done at baseline and after the second and fourth weeks. The Shapiro–Wilk test determined the normality, and the Mann–Whitney and an independent sample t-test were used to compare the variables.
Results:
The average age of participants was 33.8 years, and the study includes 46.7% males and 53.3% females. The Mann–Whitney and an independent sample t-test showed that every participant in the experimental group experienced a significant improvement in their functional status, muscle strength, pain, and knee ranges (p < 0.05). No significant differences were reported for the range of motion of left knee flexion, or strength of the left quadriceps muscles (p > 0.05).
Conclusions:
This randomised controlled trial shows that both techniques are effective for the treatment of anterior knee pain; however, the dry needling technique is a clinically more effective treatment approach to decreasing pain and improving muscle strength, knee ranges and functional status in patients.
REFERENCES (31)
1.
Foss KD, Hornsby M, Edwards NM, Myer GD, Hewett TE. Is body composition associated with an increased risk of developing anterior knee pain in adolescent female athletes?. Phys Sportsmed. 2012;40(1):13–9; doi: 10.3810/psm.2012.02.1947.
2.
Tan SS, van Linschoten RL, Van Middelkoop M, Koes BW, Bierma-Zeinstra SM, Koopmanschap MA. Cost-utility of exercise therapy in adolescents and young adults suffering from the patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(4):568–79; doi: 10.1111/j.1600-0838.2009.00980.x.
3.
Timmins KA, Leech RD, Batt ME, Edwards KL. Running and knee osteoarthritis: a systematic review and meta- -analysis. Am J Sports Med. 2017;45(6):1447–57; doi: 10.1177/0363546516657531.
4.
Abernethy PJ, Townsend PR, Rose RM, Radin EL. Is chondromalacia patellae a separate clinical entity?. J Bone Joint Surg Br. 1978;60-B(2):205–10; doi: 10.1302/0301-620X.60B2.659466.
5.
Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100–10; doi: 10.1097/01.blo.0000172303.74414.7d.
6.
Dippenaar DL. The association between myofascial trigger points of the quadriceps femoris muscle and the clinical presentation of patellofemoral pain syndrome using a piloted patellofemoral pain severity scale. Doctoral dissertation. Durban Institute of Technology, South Africa.
7.
Patel Z, Srivastava A, Shyam A, Sancheti P. Immediate effect of dry needling vs ultrasound on releasing trigger points in quadriceps in patients with patello-femoral pain syndrome on pain. Int J Physiother Res. 2019;7(6):3287–94; doi: 10.16965/ijpr.2019.182.
8.
Behrangrad S, Kamali F. Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: a double-blind randomized clinical trial. J Bodyw Mov Ther. 2017;21(3):554–64; doi: 10.1016/j.jbmt.2016.08.007.
9.
Simons DG, Travell JG, Simons LS, Cummings BD. Myofascial Pain and Dysfunction. The Trigger Point Manual. Vol. 1: Upper Half of Body. Williams and Wilkins; 1999.
10.
Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil. 2001;80(10):729–35; doi: 10.1097/00002060-200110000-00004.
11.
Shakeri H, Soleimanifar M, Nejad L, Arab AM. Dry needling versus Kinesio Taping on myofascial trigger point in the vastus lateralis muscle in subject with patellofemoral pain syndrome. J Musculoskelet Res. 2019;22(01n02):1950005; doi: 10.1142/S0218957719500052.
12.
Ma Y-T, Li L-H, Han Q, Wang X-L, Jia P-Y, Huang Q-M, Zheng Y-J. Effects of trigger point dry needling on neuromuscular performance and pain of individuals affected by patellofemoral pain: a randomized controlled trial. J Pain Res. 2020:1677–86; doi: 10.2147/JPR.S278493. Erratum: J Pain Res. 2020;13:2237; doi: 10.2147/JPR.S278493.
13.
Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, Choi PE, Jung JW, Cornett E, Kaye AD, Viswanath O. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol. 2020;34(3):427–48; doi: 10.1016/j.bpa.2020.08.003.
14.
Korkmaz MD, Ceylan CM. Effect of dry-needling and exercise treatment on myofascial trigger point: a single-blind randomized controlled trial. Complement Ther Clin Pract. 2022;47:101571; doi: 10.1016/j.ctcp.2022.101571.
15.
Rozenfeld E, Finestone AS, Moran U, Damri E, Kalichman L. The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients. J Bodyw Mov Ther. 2020;24(1):31–8; doi: 10.1016/j.jbmt.2019.05.010.
16.
Sutlive TG, Golden A, King K, Morris WB, Morrison JE, Moore JH, Koppenhaver S. Short-term effects of trigger point dry needling on pain and disability in subjects with patellofemoral pain syndrome. Int J Sports Phys Ther. 2018;13(3):462–73.
17.
Behrangrad S, Abbaszadeh-Amirdehi M, Kordi Yoosefinejad A, Esmaeilnejadganji SM. Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial. Acupunct Med. 2020;38(6):371–9; doi: 10.1177/0964528420912253.
18.
Abbott JH, Schmitt J. Minimum important differences for the patient-specific functional scale, 4 region-specific outcome measures, and the numeric pain rating scale. J Orthop Sports Phys Ther. 2014;44(8):560–4; doi: 10.2519/jospt.2014.5248.
19.
Prins MR, Van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15; doi: 10.1016/s0004-9514(09)70055-8.
20.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159–63; doi: 10.1016/s0749-8063(05)80366-4.
21.
Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?. Arch Phys Med Rehabil. 2004;85(5):815–22; doi: 10.1016/s0003-9993(03)00613-0.
22.
Khan I, Ahmad A, Sadiq S. Immediate effects of dry needling on pain and function among individuals with patellofemoral pain syndrome. J Islamic Int Med Coll. 2020;15(3):167–72;.
23.
Jimenez-del-Barrio S, Medrano-de-la-Fuente R, Hernando-Garijo I, Mingo-Gómez MT, Estebanez-de-Miguel E, Ceballos-Laita L. The effectiveness of dry needling in patients with hip or knee osteoarthritis: a systematic review and meta-analysis. Life. 2022;12(10):1575; doi: 10.3390/life12101575.
24.
Romero EAS, Fernández-Carnero J, Calvo-Lobo C, Ochoa Saez V, Caballero VB, Pecos-Martín D. Is a combination of exercise and dry needling effective for knee OA?. Pain Med. 2020;21(2):349–63; doi: 10.1093/pm/pnz036.
25.
Vervullens S, Meert L, Baert I, Delrue N, Heusdens CH, Hallemans A, Van Criekinge T, Smeets RJ, De Meulemeester K. The effect of one dry needling session on pain, central pain processing, muscle co-contraction and gait characteristics in patients with knee osteoarthritis: a randomized controlled trial. Scand J Pain. 2022;22(2):396–409; doi: 10.1515/sjpain-2021-0091.
26.
Farazdaghi M, Yoosefinejad AK, Abdollahian N, Rahimi M, Motealleh A. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther. 2021;27:597–604; doi: 10.1016/j.jbmt.2021.04.011.
27.
Rahou-El-Bachiri Y, Navarro-Santana MJ, Gómez-Chiguano GF, Cleland JA, López-de-Uralde-Villanueva I, Fernández-de-Las-Peñas C, Ortega-Santiago R, Plaza-Manzano G. Effects of trigger point dry needling for the management of knee pain syndromes: a systematic review and meta-analysis. J Clin Med. 2020;9(7):2044; doi: 10.3390/jcm9072044.
28.
Ughreja RA, Prem V. Effectiveness of dry needling techniques in patients with knee osteoarthritis: a systematic review and meta-analysis. J Bodyw Mov Ther. 2021;27:328–38; doi: 10.1016/j.jbmt.2021.02.015.
29.
Hott A, Liavaag S, Juel NG, Brox JI. Study protocol: a randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskelet Disord. 2015;16:40; doi: 10.1186/s12891-015-0493-6.
30.
Earl JE, Hoch AZ. A proximal strengthening program improves pain, function, and biomechanics in women with patellofemoral pain syndrome. Am J Sports Med. 2011;39(1):154–63; doi: 10.1177/0363546510379967.
31.
Amani M, Shafizadegan Z, Taheri N. Effects of dry needling on pain in patients with knee osteoarthritis: a preliminary study. Adv Biomed Res. 2022;11(1):47; doi: 10.4103/abr.abr_102_21.
Share
RELATED ARTICLE
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
