Dry Needling and Stretching vs. Stretching Alone on Hamstring Flexibility in Patients With Knee Pain
| Status: | Completed |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 4/21/2016 |
| Start Date: | November 2014 |
| End Date: | October 2015 |
The Effectiveness of Dry Needling and Stretching vs. Stretching Alone on Hamstring Flexibility in Patients With Knee Pain: A Randomized Controlled Trial
The purposes of this double-blinded, randomized controlled trial are (1) to determine if the
addition of trigger point dry needling (TDN) to a standard stretching program results in
greater improvements in hamstring flexibility versus stretching alone in a population with
atraumatic knee pain; (2) measure length of time that flexibility gains are maintained, (3)
assess resulting movement mechanics and (4) assess patient reported changes in pain.
Findings will potentially lead to insights as to the benefit of applying this intervention
to additional body regions.
addition of trigger point dry needling (TDN) to a standard stretching program results in
greater improvements in hamstring flexibility versus stretching alone in a population with
atraumatic knee pain; (2) measure length of time that flexibility gains are maintained, (3)
assess resulting movement mechanics and (4) assess patient reported changes in pain.
Findings will potentially lead to insights as to the benefit of applying this intervention
to additional body regions.
In this study, up to 40 subjects with a history of atraumatic knee pain will be randomized
into 2 groups of up to 20 subjects per group (1 experimental group and 1 control group).
Subjects in the experimental group will receive TDN intervention with hamstring stretching
while subjects in the control group will receive an alternative needling intervention with
hamstring stretching. After meeting all inclusion criteria, all subjects will undergo the
following tests: supine active knee extension, the active straight leg raise test, deep
squat, and a single leg step down from a 6 inch step. Subjects who measure less than 20°
from full extension on the active knee extension test will be excluded. Hamstring tightness
has been operationally defined as having greater than 20° loss of knee extension as measured
with the femur held at 90° of hip flexion.[1] Manual palpation of the bilateral biceps
femoris, semitendinosus, and semimembranosus will be performed to detect the presence of
myofascial trigger points (TPs) in groups 1 and 2. Dry needling will be performed to all
detected TPs by a provider trained and experienced in TDN. Post TDN, all tests will be
immediately repeated and at each follow up the subject will complete the Global Rating of
Change survey (GROC) and Lower Extremity Functional Scale (LEFS).
Post intervention, subjects in experimental group 1 will be given a standing hamstring
stretch to perform 1 repetition held for 30 seconds, repeated 3 times daily. These
parameters have been shown to be effective at improving flexibility.[2] Subjects will be
instructed by demonstration and will be provided with a handout of stretching instructions.
Subjects will be given an exercise log to record home exercise compliance.
Subjects in group 2 will be given an alternative needling intervention followed by a
standing hamstring stretch to perform 3 times per day, 1 repetition held for 30 seconds.
Alternative needling intervention will be performed to give the appearance of regular TDN
intervention; however, no needle penetration will be performed. Following alternative
needling intervention, subjects will be instructed by demonstration and will be provided
with a handout of hamstring stretching instructions. Home exercise compliance will be
recorded at each follow up.
Follow up measurements will be recorded between 1-2 days, 3-4 days, and 7-8 days post
intervention. All tests will be repeated. One additional session of TDN and alternative
needling intervention will be performed at day 3-4.
into 2 groups of up to 20 subjects per group (1 experimental group and 1 control group).
Subjects in the experimental group will receive TDN intervention with hamstring stretching
while subjects in the control group will receive an alternative needling intervention with
hamstring stretching. After meeting all inclusion criteria, all subjects will undergo the
following tests: supine active knee extension, the active straight leg raise test, deep
squat, and a single leg step down from a 6 inch step. Subjects who measure less than 20°
from full extension on the active knee extension test will be excluded. Hamstring tightness
has been operationally defined as having greater than 20° loss of knee extension as measured
with the femur held at 90° of hip flexion.[1] Manual palpation of the bilateral biceps
femoris, semitendinosus, and semimembranosus will be performed to detect the presence of
myofascial trigger points (TPs) in groups 1 and 2. Dry needling will be performed to all
detected TPs by a provider trained and experienced in TDN. Post TDN, all tests will be
immediately repeated and at each follow up the subject will complete the Global Rating of
Change survey (GROC) and Lower Extremity Functional Scale (LEFS).
Post intervention, subjects in experimental group 1 will be given a standing hamstring
stretch to perform 1 repetition held for 30 seconds, repeated 3 times daily. These
parameters have been shown to be effective at improving flexibility.[2] Subjects will be
instructed by demonstration and will be provided with a handout of stretching instructions.
Subjects will be given an exercise log to record home exercise compliance.
Subjects in group 2 will be given an alternative needling intervention followed by a
standing hamstring stretch to perform 3 times per day, 1 repetition held for 30 seconds.
Alternative needling intervention will be performed to give the appearance of regular TDN
intervention; however, no needle penetration will be performed. Following alternative
needling intervention, subjects will be instructed by demonstration and will be provided
with a handout of hamstring stretching instructions. Home exercise compliance will be
recorded at each follow up.
Follow up measurements will be recorded between 1-2 days, 3-4 days, and 7-8 days post
intervention. All tests will be repeated. One additional session of TDN and alternative
needling intervention will be performed at day 3-4.
Inclusion Criteria:
- Department of Defense healthcare beneficiaries
- 18-40 years old
- atraumatic knee pain greater than 2 weeks in duration
- Lack of 20 degrees or more of active supine knee extension
Exclusion Criteria:
- History of herniated lumbar disc/radiculopathy
- Prior surgery in the hip, knee or back
- Self-Reported Pregnancy
- History of blood borne pathogens/infectious disease/active infection/metal allergy
- Knee pain of traumatic origin, instability, joint line tenderness, or positive
meniscal tests
- Participants who are not fluent in English
- Previous history of TDN
- Bleeding disorders or currently taking anti-coagulant medications
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