An ahead of print article on Dry Needling for PFP from JOSPT. From this study Dry Needling (DN) appears supported for pain with OA and s/p TKA’s, but no difference in PFP. Both groups received Manual therapy and exercise, with one group additionally receiving DN. The dry needling approach seems to be more of the aggressive versions (which is good), but no stim was provided. It is noted that both groups did improve significantly from baseline. Not sure if more than 3 sessions of DN is needed as there is no evidence based dosage information. Limitations of the study included: 3 month f/u, no control group or no intervention group to see if pts improved similarly without tx, better outcomes may be achieved with modifications to manual therapy and exercise loads, and no sham or blinding to needling.
Study Design: Randomized controlled trial.
Background: Evidence suggests that multimodal interventions including exercise therapy may be effective for patellofemoral pain (PFP), however no study has investigated the effects of trigger point dry needling (TrP-DN) in people with PFP.
Objectives To compare the effects of adding TrP-DN into 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). The manual therapy and exercise plus TrP-DN 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 KOOS, the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), and the numerical pain rate scale
(NPRS). Patients were assessed at baseline, 15 days (post-treatment) and 3 months follow-up. Analysis was with mixed ANCOVAs adjusted for baseline scores.
Results: At 3 months, 58 subjects (97%) completed the follow-up. No significant between groups differences (all, P>0.391) were observed for any outcome: KOOS-P, mean difference -2.1 (95%CI -4.6, 0.4); IKDC, 2.3 (-0.1, 4.7); knee pain intensity, 0.3 (-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-SP subscale surpassed the pre-specified minimum important change.
Conclusions: The current clinical trial suggests that the inclusion of 3 sessions of TrP-DN into 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 on
Key Words: dry needling, manual therapy, exercise, patellofemoral pain
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