Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners

Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.

Postrace Dry Needling Does Not Reduce Subsequent Soreness and Cramping-A Randomized Controlled Trial

OBJECTIVE

To identify whether a single session of postrace dry needling can decrease postrace soreness and quantity of postrace leg cramps in half-marathon and full-marathon runners.

DESIGN

Single-blind, prospective, randomized, controlled trial.

SETTING

Finish line of 2018 Salt Lake City Marathon & Half-Marathon.

PARTICIPANTS

Runners aged 18 years or older who completed a marathon or half-marathon.

INTERVENTIONS

True or sham dry needling of the bilateral vastus medialis and soleus muscles within 1 hour of race completion by 2 experienced practitioners.

MAIN OUTCOME MEASURES

The primary outcome measure was numeric pain rating improvements for soreness on days 1, 2, 3, and 7 compared to immediately postrace. Secondary outcome measures included number of postrace cramps and subjective improvement of soreness.

RESULTS

Sixty-two runners were included with 28 receiving true and 34 receiving sham dry needling. Objective pain scores showed an increase in pain of the soleus muscles at days 1 and 2 (P ≤ 0.003 and P ≤ 0.041, respectively) in the dry needling group. No differences were seen in postrace pain in the vastus medialis muscles (P > 0.05). No association was seen between treatment group and presence of postrace cramping at any time point (P > 0.05). Subjectively, there was a nonsignificant trend for those receiving dry needling to feel better than expected over time (P = 0.089), but no difference with cramping (P = 0.396).

CONCLUSIONS

A single postrace dry needling session does not objectively improve pain scores or cramping compared to sham therapy.

Validity of a Sham Dry Needling Technique on a Healthy Population

BACKGROUND

Various methods of sham procedures have been used in controlled trials evaluating dry needling efficacy although few have performed validation studies of the sham procedure.

HYPOTHESIS/PURPOSE

The purpose of this study was to examine the validity of a sham dry needling technique on healthy, active subjects.

STUDY DESIGN

Validation study.

METHODS

Runners capable of completing a half-marathon or marathon race and were randomized to receive true (using an introducer and needle) or sham (using an introducer and fixed, blunted needle) dry needling. Blinded subjects were asked to identify if they received sham or true dry needling following the procedure. Proportions of those who correctly identified their needling were also examined on the basis of past experience of receiving dry needling.

RESULTS

Fifty-three participants were included in this study, with 25 receiving the true dry needling procedure and 28 receiving the sham. Of those who had received dry needling in the past (n = 16), 11 (68.8%) correctly identified their respective groups. For those who had not previously received dry needling (n = 37), 13 (35.1%) accurately identified their group. Most importantly, 94.1% of dry needling-naïve participants were unable to identify they received the sham procedure (p < 0.001).

CONCLUSIONS

This study shows that a fixed needle in an introducer tube is a simple, inexpensive, effective sham procedure in patients who have never received dry needling before. This technique may be useful for randomized controlled trials in the future.

LEVELS OF EVIDENCE

2.