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Jenkins LC, Summers SJ, Nasser A, Verhagen A. Dry needling perceptions and experiences: A survey of Australian physiotherapists. Musculoskelet Sci Pract 2024; 69:102895. [PMID: 38081107 DOI: 10.1016/j.msksp.2023.102895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND There is a lack of information on the use of dry needling in Australian physiotherapy practice. OBJECTIVES Our primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DESIGN Cross-sectional online survey. METHOD We developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. RESULTS/FINDINGS We invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). CONCLUSIONS We found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.
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Affiliation(s)
- Luke C Jenkins
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia.
| | - Simon J Summers
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Nasser
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
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Osborne JWA, Menz HB, Whittaker GA, Landorf KB. Development of a foot and ankle strengthening program for the treatment of plantar heel pain: a Delphi consensus study. J Foot Ankle Res 2023; 16:67. [PMID: 37789375 PMCID: PMC10546707 DOI: 10.1186/s13047-023-00668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND People with plantar heel pain (PHP) have reduced foot and ankle muscle function, strength and size, which is frequently treated by muscle strengthening exercises. However, there has been little investigation of what exercises are used and there is no sound evidence base to guide practice. This study aimed to develop a consensus-driven progressive muscle strengthening program for PHP. METHODS Thirty-eight experts were invited to participate in the study over three rounds. Round 1 was an open-ended questionnaire that provided the core characteristics of progressive strengthening programs designed for three different adult patient types with PHP (younger athletic, overweight middle-aged, older), which were presented as vignettes. In Round 2, experts indicated their agreement to the proposed exercises and training variables. In Round 3, experts were presented with amendments to the exercises based on responses from Round 2 and indicated their agreement to those changes. Consensus was achieved when > 70% of experts agreed. RESULTS Two experts were ineligible and 12 declined, leaving 24 (67%) who participated in Round 1. Eighteen (75%) completed all three rounds. From Round 1, progressive strengthening programs were developed for the three vignettes, which included 10 different exercises and three training variables (sets / repetitions, weight, and frequency). In Round 2, 68% (n = 17) of exercises and 96% (n = 72) of training variables reached consensus. In Round 3, only exercise changes were presented and 100% of exercises reached consensus. CONCLUSIONS This study provides three progressive strengthening programs agreed to by experts that can be used in future clinical trials to determine the effectiveness of muscle strengthening for PHP. In addition, clinicians could use the programs as part of a rehabilitation strategy with the caveat that they may change as more research is conducted.
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Affiliation(s)
- John W A Osborne
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, 3086, Australia.
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, 3086, Australia
| | - Glen A Whittaker
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, 3086, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, 3086, Australia
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Salehi S, Shadmehr A, Olyaei G, Bashardoust S, Mir SM. Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial. Physiother Theory Pract 2023; 39:490-503. [PMID: 35094649 DOI: 10.1080/09593985.2021.2023930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Plantar fasciitis is a common problem in the foot region which has negative considerable impact on foot function. METHODS In this parallel blinded randomized controlled trial, a total of thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly to either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All interventions lasted six weeks and both groups were followed for two weeks. Primary outcomes were first step pain, pain, and activity daily function subscales of the FAOS questionnaire and secondary outcomes were plantar fascia thickness, and echogenicity. RESULTS The mixed model ANOVAs showed significant group × time interactions for all primary outcomes. In both groups, first step pain and both subscales of the FAOS questionnaire were improved compared to baseline measurements. There were considerable differences between the two groups and the experimental group experienced more improvements in primary outcomes compared to the control group. For secondary outcomes, plantar fascia thickness at insertion significantly decreased, and the echogenicity in the two regions significantly increased in the experimental group compared to the control group. CONCLUSION These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.
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Affiliation(s)
- Saman Salehi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadmehr
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Olyaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Bashardoust
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Mir
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis. J Sport Rehabil 2021; 31:299-304. [PMID: 34911041 DOI: 10.1123/jsr.2021-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/20/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles. METHODS In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups. RESULTS There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups. CONCLUSION The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles. LEVEL OF EVIDENCE Level 1, randomized controlled trial.
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Llurda-Almuzara L, Labata-Lezaun N, Meca-Rivera T, Navarro-Santana MJ, Cleland JA, Fernández-de-Las-Peñas C, Pérez-Bellmunt A. Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:1630-1641. [PMID: 33760098 DOI: 10.1093/pm/pnab114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Dry needling is commonly used for the management of plantar fasciitis. This meta-analysis evaluated the effects of dry needling over trigger points associated with plantar heel pain on pain intensity and related disability or function. METHODS Electronic databases were searched for randomized controlled trials in which at least one group received dry needling, not acupuncture, for trigger points associated with plantar heel pain and in which outcomes were collected on pain intensity and related disability. The risk of bias was assessed with the Cochrane Risk of Bias tool, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the level of evidence is reported according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated. RESULTS The search identified 297 publications, with six trials eligible for inclusion. The meta-analysis found low-quality evidence that trigger point dry needling reduces pain intensity in the short term (MD -1.70 points, 95% confidence interval [CI] -2.80 to -0.60; SMD -1.28, 95% CI -2.11 to -0.44) and moderate-quality evidence that it improves pain intensity (MD -1.77 points, 95% CI -2.44 to -1.11; SMD -1.45, 95% CI -2.19 to -0.70) and related disability (SMD -1.75, 95% CI -2.22 to -1.28) in the long term, as compared with a comparison group. The risk of bias of the trials was generally low, but the heterogeneity of the results downgraded the level of evidence. DISCUSSION Moderate- to low-quality evidence suggests a positive effect of trigger point dry needling for improving pain intensity and pain-related disability in the short term and long term, respectively, in patients with plantar heel pain of musculoskeletal origin. The present results should be considered with caution because of the small number of trials.
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Affiliation(s)
| | - Noé Labata-Lezaun
- Universitat Internacional de Catalunya (UIC-Barcelona), Barcelona, Spain
| | - Toni Meca-Rivera
- Universitat Internacional de Catalunya (UIC-Barcelona), Barcelona, Spain.,Médico Quirónsalud Aribau, Barcelona, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, Day J, Fernández-de-Las-Peñas C. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J 2021; 21:284-295. [PMID: 33065273 DOI: 10.1016/j.spinee.2020.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other. PURPOSE The present study aims to compare the combined effects of spinal manipulation and dry needling with spinal mobilization and exercise on pain and disability in individuals with CH. STUDY DESIGN/SETTING Randomized, multicenter, parallel-group trial. PATIENT SAMPLE One hundred forty-two patients (n=142) with CH from 13 outpatient clinics in 10 different states were recruited over a 36-month period. OUTCOME MEASURES The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale. Secondary outcomes included headache frequency and duration, disability (Neck Disability Index), medication intake, and the Global Rating of Change (GROC). Follow-up assessments were taken at 1 week, 4 weeks, and 3 months. METHODS Patients were randomized to receive upper cervical and upper thoracic spinal manipulation plus electrical dry needling (n=74) or upper cervical and upper thoracic spinal mobilization and exercise (n=68). In addition, the mobilization group also received a program of craniocervical and peri-scapular resistance exercises; whereas, the spinal manipulation group also received up to eight sessions of perineural electrical dry needling. The treatment period for both groups was 4 weeks. The trial was prospectively registered at ClinicalTrials.gov (NCT02373605). Drs Dunning, Butts and Young are faculty within the AAMT Fellowship and teach postgraduate courses in spinal manipulation, spinal mobilization, dry needling, exercise and differential diagnosis. The other authors declare no conflicts of interest. None of the authors received any funding for this study. RESULTS The 2 × 4 analysis of covariance revealed that individuals with CH who received thrust spinal manipulation and electrical dry needling experienced significantly greater reductions in headache intensity (F=23.464; p<.001), headache frequency (F=13.407; p<.001), and disability (F=10.702; p<.001) than those who received nonthrust mobilization and exercise at a 3-month follow-up. Individuals in the spinal manipulation and electrical dry needling group also experienced shorter duration of headaches (p<.001) at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2=54.840; p<.001) more patients (n=57, 77%) within the spinal manipulation and electrical dry needling group achieved a successful outcome compared to the mobilization and exercise group (n=10, 15%) at 3-month follow-up. Between-groups effect sizes were large (0.94<standardized mean score difference<1.25) in all outcomes in favor of the spinal manipulation and electrical dry needling group at 3 months. In addition, significantly (X2=29.889; p<.001) more patients in the spinal manipulation and electrical dry needling group (n=49, 66%) completely stopped taking medication for their pain compared to the spinal mobilization and exercise group (n=14, 21%) at 3 months. CONCLUSION Upper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; PRISMA Health Physical Therapy Specialists, Columbia, SC, USA
| | - Noah Zacharko
- Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | - Keith Fandry
- Back in Action Physical Therapy, Scottsdale, AZ, USA
| | - Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Tybee Wellness & Osteopractic, Tybee Island, GA, USA
| | - Kenneth Wheeler
- ClearCut ORTHO Physical Therapy Specialists, Fort Worth, TX, USA
| | - Jennell Day
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Cátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, Madrid, Spain
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Gattie E, Cleland JA, Snodgrass S. A survey of American physical therapists' current practice of dry needling: Practice patterns and adverse events. Musculoskelet Sci Pract 2020; 50:102255. [PMID: 32932050 DOI: 10.1016/j.msksp.2020.102255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To estimate the proportion of physical therapists currently performing dry needling and report current practices patterns. Secondary aims were to report the numbers of minor and major adverse events and determine if these adverse events were related to therapist characteristics. METHODS An anonymous electronic survey was distributed through special interest groups within the United States to physical therapists. Participant demographics and responses were analyzed using descriptive statistics. Associations between variables were examined using chi-square. RESULTS The estimated response rate was 14.4% (n = 865, mean age 39.89, SD 11.73 years). More than half (55.0%, n = 461) of respondents perform dry needling; levels of training varied. Most (78.8%, n = 337) performed 0-3 needling sessions per day, usually lasting < 15 min (67.3% of respondents, n = 288). Therapists commonly performed 3-6 sessions over a patient's course of care (82.0% of respondents, n = 350). Minor adverse events were common; respondents estimated this occurred in 39.6% (SD 31.5) of treatments. Major adverse events were rare, typically not requiring emergency care. Being male (X2 = 8.197, P = 0.004), experienced (>4 years; X2 = 34.635, P < 0.001), and having more training (>61 h; X2 = 8.503, P = 0.004) were associated with reporting a major adverse event occurred during their career. CONCLUSIONS Half of physical therapists surveyed performed dry needling. Practice patterns were consistent with expert opinion. The number of adverse events reported suggests further research is needed to quantify the risks of dry needling. Participant characteristics associated with a major adverse event appear to be related to the number of exposures.
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Affiliation(s)
- Eric Gattie
- Concord Hospital Rehabilitation Services, Concord, NH, USA.
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Suzanne Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callahgan, NSW, Australia
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Ortega-Santiago R, Ríos-León M, Martín-Casas P, Fernández-de-Las-Peñas C, Plaza-Manzano G. Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case-Control Study. PAIN MEDICINE 2020; 21:1032-1038. [PMID: 30986304 DOI: 10.1093/pm/pnz086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. METHODS A case-control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject's condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0-10), the Foot Function Index, and the Foot Health Status Questionnaire. RESULTS The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (-0.447 < rs < -0.35456, P < 0.05). CONCLUSIONS The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.
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Affiliation(s)
- Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca
| | - Marta Ríos-León
- Alumna de Doctorado, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Towards more homogenous and rigorous methods in sham-controlled dry needling trials: two Delphi surveys. Physiotherapy 2020; 106:12-23. [DOI: 10.1016/j.physio.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 12/23/2022]
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10
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Abbasian M, Baghbani S, Barangi S, Fairhurst PG, Ebrahimpour A, Krause F, Hashemi M. Outcomes of Ultrasound-Guided Gastrocnemius Injection With Botulinum Toxin for Chronic Plantar Fasciitis. Foot Ankle Int 2020; 41:63-68. [PMID: 31587569 DOI: 10.1177/1071100719875220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment. METHODS Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection. RESULTS At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group (P < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up. CONCLUSION In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment. LEVEL OF EVIDENCE Level I, prospective randomized controlled trial.
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Affiliation(s)
- Mohammadreza Abbasian
- Department of Orthopedics, Akhtar Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salar Baghbani
- Department of Orthopedics, Akhtar Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Barangi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Paul Gilbert Fairhurst
- Department of Orthopaedics, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - Adel Ebrahimpour
- Department of Orthopedics, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fabian Krause
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, Berne, Switzerland
| | - Masoud Hashemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dommerholt J, Chou LW, Finnegan M, Hooks T. A critical overview of the current myofascial pain literature - February 2019. J Bodyw Mov Ther 2019; 23:295-305. [PMID: 31103111 DOI: 10.1016/j.jbmt.2019.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/26/2022]
Abstract
This edition of the overview of current myofascial pain literature features several interesting and important publications. From Australia, Braithwaite and colleagues completed an outstanding systematic review of blinding procedures used in dry needling (DN) studies. Other papers tackled the interrater reliability of the identification of trigger points (TrP), the presence of muscle hardness related to latent TrPs, pelvic floor examination techniques, and the links between TrPs, headaches and shoulder pain. Israeli researchers developed a theoretical model challenging the contributions of the Cinderella Hypothesis to the development of TrPs. As in almost all issues, we included many DN, injection and acupuncture studies, which continue to be the focus of researchers all over the world.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | | | - Michelle Finnegan
- Myopain Seminars, Bethesda, MD, USA; ProMove PT Pain Specialists, Bethesda, MD, USA.
| | - Todd Hooks
- Myopain Seminars, Bethesda, MD, USA; New Orleans Pelicans, New Orleans, LA, USA.
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Marti-Martinez LM, Gracia-Sánchez A, Ferrer-Torregrosa J, Lorca-Gutierrez R, Garcia-Campos J, Sánchez-Pérez SP. Description of the surgical technique for condylectomy with minimally invasive surgery to treat interdigital helomas on the lesser toes: a Delphi study. J Foot Ankle Res 2019; 12:13. [PMID: 30815036 PMCID: PMC6376773 DOI: 10.1186/s13047-019-0322-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/06/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Descriptions of the techniques for condylectomies via minimally invasive surgery (MIS) to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique. METHODS This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a 43-items questionnaire via e-mail. Statements with an average score ≥ 3 were included in the next round, as were those in which none of the three statements reached the minimum score of 3 within the same item. RESULTS Response rate: 90%. Three rounds were needed to reach consensus on proposed items. A new statement that combined two statements was proposed in round 3. Eleven recommendations regarding the incision and instruments used to perform this surgical technique were obtained based on the expert consensus. CONCLUSIONS A longitudinal incision to the distal pulp of the toe or an incision to the centre of the plantar aspect of the head of the proximal phalanx should be performed according to the affectation, and a Beaver 64 scalpel blade, a blunt elevator and a Shannon-Isham burr are the most acceptable tools for this kind of surgery.
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Affiliation(s)
- Luis M. Marti-Martinez
- Behavioural and Health Sciences Department, Miguel Hernandez University, Ctra. Nnal. 332 s/n, 03550 San Juan de Alicante, Spain
| | - Alba Gracia-Sánchez
- University Clinic of Podiatry, Complutense de Madrid University, Av. Seneca, 2, 28040 Madrid, Spain
| | - Javier Ferrer-Torregrosa
- Physiotherapy and Podiatry Department, Catholic university of Valencia San Vicente Mártir, C/ Ramiro de Maeztu, 14, 46900 Torrente, Spain
| | - Rubén Lorca-Gutierrez
- Physiotherapy and Podiatry Department, Catholic university of Valencia San Vicente Mártir, C/ Ramiro de Maeztu, 14, 46900 Torrente, Spain
| | - Jonatan Garcia-Campos
- Behavioural and Health Sciences Department, Miguel Hernandez University, Ctra. Nnal. 332 s/n, 03550 San Juan de Alicante, Spain
| | - Salvador Pedro Sánchez-Pérez
- Behavioural and Health Sciences Department, Miguel Hernandez University, Ctra. Nnal. 332 s/n, 03550 San Juan de Alicante, Spain
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Dunning J, Butts R, Henry N, Mourad F, Brannon A, Rodriguez H, Young I, Arias-Buría JL, Fernández-de-las-Peñas C. Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial. PLoS One 2018; 13:e0205405. [PMID: 30379937 PMCID: PMC6209187 DOI: 10.1371/journal.pone.0205405] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022] Open
Abstract
Study Design Randomized, single-blinded, multi-center, parallel-group trial. Objectives To compare the effects of adding electrical dry needling into a program of manual therapy, exercise and ultrasound on pain, function and related-disability in individuals with plantar fasciitis (PF). Background The isolated application of electrical dry needling, manual therapy, exercise, and ultrasound has been found to be effective for PF. However, no previous study has investigated the combined effect of these interventions in this population. Methods One hundred and eleven participants (n = 111) with plantar fasciitis were randomized to receive electrical dry needling, manual therapy, exercise and ultrasound (n = 58) or manual therapy, exercise and ultrasound (n = 53). The primary outcome was first-step pain in the morning as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included resting foot pain (NPRS), pain during activity (NPRS), the Lower Extremity Functional Scale (LEFS), the Foot Functional Index (FFI), medication intake, and the Global Rating of Change (GROC). The treatment period was 4 weeks with follow-up assessments at 1 week, 4 weeks, and 3 months after the first treatment session. Both groups received 6 sessions of impairment-based manual therapy directed to the lower limb, self-stretching of the plantar fascia and the Achilles tendon, strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound. In addition, the dry needling group also received 6 sessions of electrical dry needling using a standardized 8-point protocol for 20 minutes. The primary aim was examined with a 2-way mixed-model analysis of covariance (ANCOVA) with treatment group as the between-subjects variable and time as the within-subjects variable after adjusting for baseline outcomes. Results The 2X4 ANCOVA revealed that individuals with PF who received electrical dry needling, manual therapy, exercise and ultrasound experienced significantly greater improvements in first-step morning pain (F = 22.021; P<0.001), resting foot pain (F = 23.931; P<0.001), pain during activity (F = 7.629; P = 0.007), LEFS (F = 13.081; P<0.001), FFI Pain Subscale (F = 13.547; P<0.001), FFI Disability Subscale (F = 8.746; P = 0.004), and FFI Total Score (F = 10.65; P<0.001) than those who received manual therapy, exercise and ultrasound at 3 months. No differences in FFI Activity Limitation Subscale (F = 2.687; P = 0.104) were observed. Significantly (X2 = 9.512; P = 0.023) more patients in the electrical dry needling group completely stopped taking medication for their pain compared to the manual therapy, exercise and ultrasound group at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2 = 45.582; P<0.001) more patients within the electrical dry needling group (n = 45, 78%) achieved a successful outcome compared to the manual therapy, exercise and ultrasound group (n = 11, 21%). Effect sizes ranged from medium to large (0.53<SMD<0.85) at 3 months in favor of the electrical dry needling group. Conclusion The inclusion of electrical dry needling into a program of manual therapy, exercise and ultrasound was more effective for improving pain, function and related-disability than the application of manual therapy, exercise and ultrasound alone in individuals with PF at mid-term (3 months). Level of evidence Therapy, Level 1b.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- * E-mail:
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- Research Physical Therapy Specialists, Columbia, South Carolina, United States of America
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- Troop Medical Clinic, Eglin Air Force Base, Florida, United States of America
| | - Firas Mourad
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Universita di Roma Tor Vergata, Italy
| | - Amy Brannon
- TOPS Physical Therapy and Orthopaedics, Phoenix, Arizona, United States of America
| | - Hector Rodriguez
- Manual Physical Therapy Specialists, El Paso, Texas, United States of America
| | - Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama, United States of America
- CORA Physical Therapy, Savannah, Georgia, United States of America
| | - Jose L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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A Comparison of the Efficacy of Dry-Needling and Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.68908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Fleckenstein J, König M, Banzer W. Neural therapy of an athlete's chronic plantar fasciitis: a case report and review of the literature. J Med Case Rep 2018; 12:233. [PMID: 30126441 PMCID: PMC6102931 DOI: 10.1186/s13256-018-1770-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background The focus of this case report is on the role of inflammation as a contributor to pain in plantar fasciitis and its cure by the injection of local anesthetics. Case presentation This is a case report on a 24-year-old white man, a middle-distance runner, with chronic unilateral plantar fasciitis and perceived heel pain for almost 1.5 years. He was treated with neural therapy (that is, injection of < 1 ml procaine 1% which is a local anesthetic with strong anti-inflammatory properties) of the surgical scar and along the surgical puncture channel. The follow-up period from the time of first presentation until publication was 2.5 years. At admission, pain intensity (visual analog scale) in the affected leg was severe (10 cm, visual analog scale; range 0–10 cm) when walking and moderate (5 cm, visual analog scale) when standing. After the first session of injections he could stand pain-free and pain when walking was markedly reduced (− 90%). After the third session, he reported no pain in the affected leg and could return to sports at his former level (no difference in training load compared to non-injured state). There was no recurrence of inflammatory signs or heel pain despite intense athletics training up to the date of publication. Conclusions In prolonged cases of plantar fasciitis, inflammation is an important component in the development of persistent pain. The results of our case describe the effects of three neural therapy sessions that abolished inflammation and associated heel pain. Neural therapy might be an effective and time-efficient approach in the treatment of plantar fasciitis, enabling an early return to sports.
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Affiliation(s)
- J Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University Frankfurt, Ginnheimer Landstr. 39, D-60487, Frankfurt am Main, Germany. .,Department of TCM/Acupuncture, Institute of Complementary Medicine, University of Bern, Freiburgstr. 46, CH-3010, Bern, Switzerland.
| | - M König
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University Frankfurt, Ginnheimer Landstr. 39, D-60487, Frankfurt am Main, Germany.,Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Rd, SE1 0AA, London, UK
| | - W Banzer
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University Frankfurt, Ginnheimer Landstr. 39, D-60487, Frankfurt am Main, Germany
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Gatt A, Grech M, Chockalingam N, Formosa C. A Preliminary Study on the Effect of Computer-Aided Designed and Manufactured Orthoses on Chronic Plantar Heel Pain. Foot Ankle Spec 2018; 11:112-116. [PMID: 28513217 DOI: 10.1177/1938640017709906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot. METHOD Participants presenting with CPHP of more than 6 months' duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI). RESULTS There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003). CONCLUSION CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks' use. LEVELS OF EVIDENCE Therapeutic, Level IV: Prospective, comparative trial.
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Affiliation(s)
- Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Mark Grech
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
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Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial. INTERNATIONAL ORTHOPAEDICS 2017; 42:109-116. [DOI: 10.1007/s00264-017-3681-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
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On "Effectiveness of trigger point dry needling…" Cotchett MP, Munteanu SE, Landorf KB. Phys Ther. 2014;94:1083-1094. Phys Ther 2014; 94:1677-80. [PMID: 25362685 DOI: 10.2522/ptj.2014.94.11.1677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Author Response. Phys Ther 2014; 94:1680. [PMID: 25525662 DOI: 10.2522/ptj.2014.94.11.1680.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
BACKGROUND Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use. OBJECTIVE The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain. DESIGN The study was a parallel-group, participant-blinded, randomized controlled trial. SETTING The study was conducted in a university health sciences clinic. PATIENTS Study participants were 84 patients with plantar heel pain of at least 1 month's duration. INTERVENTION Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks. MEASUREMENTS Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 weeks. RESULTS At the primary end point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain=-14.4 mm, 95% confidence interval [95% CI]=-23.5 to -5.2; FHSQ foot pain=10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]). LIMITATIONS It was not possible to blind the therapist. CONCLUSION Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.
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Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. PHYSICAL THERAPY REVIEWS 2014; 19:252-265. [PMID: 25143704 PMCID: PMC4117383 DOI: 10.1179/108331913x13844245102034] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs). OBJECTIVES To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. MAJOR FINDINGS According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. 'sensitive loci' or 'nociceptors') when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. CONCLUSIONS Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical 'acupuncture' literature that have used the very same 'dry needles' to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just 'TrPs'.
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Affiliation(s)
- James Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA
- American Academy of Manipulative Therapy, Montgomery, AL, USA
| | - Raymond Butts
- University of South Carolina, Columbia, SC, USA
- Palmetto Health Research Physical Therapy Specialists, Columbia, SC, USA
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Clinical applications of platelet-rich plasma in patellar tendinopathy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:249498. [PMID: 25136568 PMCID: PMC4127290 DOI: 10.1155/2014/249498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/09/2014] [Indexed: 12/16/2022]
Abstract
Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.
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Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of jumper's knee in athletes. Am J Sports Med 2013; 41:795-803. [PMID: 23408591 DOI: 10.1177/0363546513475345] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. PURPOSE To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper's knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Forty-six consecutive athletes with jumper's knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm(2) per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. RESULTS The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). CONCLUSION Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper's knee in athletes.
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Affiliation(s)
- Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, Rome, Italy 00189.
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Lee S, Kim JE, Kim JH, Kim TH, Choi SM. Acupuncture and related interventions for treating plantar heel pain in adults. Hippokratia 2013. [DOI: 10.1002/14651858.cd010394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Seunghoon Lee
- Korea Institute of Oriental Medicine; Acupuncture, Moxibustion & Meridian Research Group, Medical Research Division; 461-24, Jeonmindong, Yuseonggu Dae-jeon Korea, South 305-811
- Kyung Hee University; Department of Acupuncture & Moxibustion, College of Korean Medicine; 26 Kyunghee-daero, Dongdaemun-gu Seoul Korea, South 130-701
| | - Jung-Eun Kim
- Korea Institute of Oriental Medicine; Acupuncture, Moxibustion & Meridian Research Group, Medical Research Division; 461-24, Jeonmindong, Yuseonggu Dae-jeon Korea, South 305-811
| | - Joo-Hee Kim
- Korea Institute of Oriental Medicine; Acupuncture, Moxibustion & Meridian Research Group, Medical Research Division; 461-24, Jeonmindong, Yuseonggu Dae-jeon Korea, South 305-811
| | - Tae-Hun Kim
- Kyung Hee University; Department of Cardiovascular & Neurologic Diseases, College of Oriental Medicine; Graduate School Seoul Korea, South
| | - Sun-Mi Choi
- Korea Institute of Oriental Medicine; Acupuncture, Moxibustion & Meridian Research Group, Medical Research Division; 461-24, Jeonmindong, Yuseonggu Dae-jeon Korea, South 305-811
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