Journal of Research in Rehabilitation Sciences

Design of a Clinical Trial Study to Evaluate the Effect of Dry Needling of Gluteus Medius Muscle on Pain and Function of Women with Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial Protocol

Document Type : Original Articles

Authors

1 Associate Professor, Department of Physical Therapy, School of Rehabilitation Sciences AND Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 MSc Student, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

3 PhD Student, Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Department of Epidemiology and Biostatistics, School of Health AND Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Ira

10.22122/jrrs.v16i0.3481

Abstract

Introduction: The aim of this study is to design a double blind randomized clinical trial in order to investigate the effect of dry needling of gluteus medius muscle on pain and function of women with patellofemoral pain syndrome (PFPS).Materials and Methods: In this clinical trial, 30 women with PFPS were randomly divided into the two treatment and control groups. Both groups received a conventional knee physiotherapy program that included two exercises for quadriceps muscle (15 minutes total) and high frequency transcutaneous electrical nerve stimulation (TENS) two times a week for three weeks. The treatment group also received dry needling once a week for three weeks with a fast-in and fast-out technique 10 times in the active trigger point of the gluteus medius muscle. The outcomes included pain and physical function, with the pain intensity and physical function measured using the visual analogue scale (VAS) and the Kujala questionnaire, respectively. The Shapiro-Wilk test was employed to check the distribution of data and based on the result of this test, the independent t-test was used if the data was of a normal distribution and the Mann-Whitney U test was used to compare the control and treatment groups if the data distribution was not normal.Conclusion: Today, the use of dry needling technique in the treatment of musculoskeletal problems has a growing trend in physiotherapy clinics. Given the role of the gluteus medius muscle in PFPS, the results of this study may help plan treatment programs for these patients as part of their rehabilitation.

Keywords

  1. Dye SF. The pathophysiology of patellofemoral pain: A tissue homeostasis perspective. Clin Orthop Relat Res 2005; (436): 100-10.
  2. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports 2010; 20(5): 725-30.
  3. Davis I, Powers C. Patellofemoral pain syndrome: proximal, distal, and local factors an international research retreat. J Orthop Sports Phys Ther 2010; 40(3): A1-A48.
  4. Thomee R, Augustsson J, Karlsson J. Patellofemoral pain syndrome: A review of current issues. Sports Med 1999; 28(4): 245-62.
  5. Rothermich MA, Glaviano NR, Li J, Hart JM. Patellofemoral pain: Epidemiology, pathophysiology, and treatment options. Clin Sports Med 2015; 34(2): 313-27.
  6. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 2003; 33(11): 671-6.
  7. Finnoff JT, Hall MM, Kyle K, Krause DA, Lai J, Smith J. Hip strength and knee pain in high school runners: A prospective study. PM R 2011; 3(9): 792-801.
  8. Powers CM. The influence of abnormal hip mechanics on knee injury: A biomechanical perspective. J Orthop Sports Phys Ther 2010; 40(2): 42-51.
  9. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. Int J Sports Phys Ther 2011; 6(4): 285-96.
  10. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep 2004; 8(6): 468-75.
  11. Miri Abyaneh H, Mosallanezhad Z, Mohammadalizade H, Bakhshi E, Vahedi G, Nourbakhsh MR. Physiotherapy with and without superficial dry needling affects pain and muscle strength in patients with patellofemoral pain syndrome. Iranian Rehabilitation Journal 2016; 14(1): 23-30.
  12. de-la-Llave-Rincon A, Loa-Barbero B, Palacios-Cena Ma, Salom-Moreno J, Ortega R, Ambite Quesada S, et al. Manual therapy combined with dry needling for the management of patients with patellofemoral pain syndrome. Manual Therapy 2016; 25: e82.
  13. Espi-Lopez GV, Serra-Ano P, Vicent-Ferrando J, Sanchez-Moreno-Giner M, Arias-Buria JL, Cleland J, et al. Effectiveness of inclusion of dry needling in a multimodal therapy program for patellofemoral pain: A randomized parallel-group trial. J Orthop Sports Phys Ther 2017; 47(6): 392-401.
  14. Nakagawa TH, Muniz TB, Baldon RM, Dias MC, de Menezes Reiff RB, Serrao FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: A randomized controlled pilot study. Clin Rehabil 2008; 22(12): 1051-60.
  15. Roach S, Sorenson E, Headley B, San Juan JG. Prevalence of myofascial trigger points in the hip in patellofemoral pain. Arch Phys Med Rehabil 2013; 94(3): 522-6.
  16. Avraham F, Aviv S, Ya'akobi P, Faran H, Fisher Z, Goldman Y, et al. The efficacy of treatment of different intervention programs for patellofemoral pain syndrome--a single blinded randomized clinical trial. Pilot study. ScientificWorldJournal 2007; 7: 1256-62.
  17. Simons DG, Travell JG, Simons LS. Travell and Simons' myofascial pain and dysfunction: Upper half of body. Philadelphia, PA: Williams and Wilkins; 1999.
  18. Njoo KH, Van der Does E. The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 1994; 58(3): 317-23.
  19. Wright S, Yelland M, Heathcote K, Ng SK, Wright G. Fear of needles--nature and prevalence in general practice. Aust Fam Physician 2009; 38(3): 172-6.
  20. 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.
  21. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63(Suppl 11): S240-S252.
  22. Singer B, Singer K. Anterior Knee Pain Scale. Aust J Physiother 2009; 55(2): 140.
  23. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9(2): 159-63.
  24. Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: A randomized, double-blinded, placebo-controlled trial. Am J Sports Med 2002; 30(6): 857-65.
  25. Negahban H, Pouretezad M, Yazdi MJ, Sohani SM, Mazaheri M, Salavati M, et al. Persian translation and validation of the Kujala Patellofemoral Scale in patients with patellofemoral pain syndrome. Disabil Rehabil 2012; 34(26): 2259-63.
  26. McConnell J. The management of chondromalacia patellae: A long term solution. Aust J Physiother 1986; 32(4): 215-23.
  27. Herrington LC. The inter-tester reliability of a clinical measurement used to determine the medial-lateral orientation of the patella. Man Ther 2002; 7(3): 163-7.
  28. Post WR. Patellofemoral pain: results of nonoperative treatment. Clin Orthop Relat Res 2005; (436): 55-9.
  29. Passigli S, Capacci P, Volpi E. The effects of a multimodal rehabilitation program on pain, kinesiophobia and function in a runner with patellofemoral pain. Int J Sports Phys Ther 2017; 12(4): 670-82.
  30. Kalytczak MM, Lucareli PRG, Dos Reis AC, Bley AS, Biasotto-Gonzalez DA, Correa JCF, et al. Female PFP patients present alterations in eccentric muscle activity but not the temporal order of activation of the vastus lateralis muscle during the single leg triple hop test. Gait Posture 2018; 62: 445-50.
  31. Espi-Lopez GV, Arnal-Gomez A, Balasch-Bernat M, Ingles M. Effectiveness of manual therapy combined with physical therapy in treatment of patellofemoral pain syndrome: Systematic review. J Chiropr Med 2017; 16(2): 139-46.
Journal of Research in Rehabilitation Sciences
Volume 16, Issue 1 - Serial Number 1
April 2020
Pages 118-125