Dry Needling for Knee Pain

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Knee surgery, Pregnancy, Neurological condition, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to consult with the trial coordinators for guidance.

What data supports the effectiveness of the treatment Dry Needling for knee pain?

Research shows that dry needling can reduce pain in the first month after knee surgery, and it is more effective than a placebo. Additionally, dry needling has been found to help with pain and function in people with knee pain conditions like patellofemoral pain syndrome. ^{1 2 3 4 5}

How is dry needling treatment different from other treatments for knee pain?

Dry needling is unique because it involves inserting thin needles into specific muscle areas called trigger points to relieve pain and improve function, unlike other treatments that may rely on medication or physical therapy alone. It targets the muscle's electrical activity to reduce pain and improve movement, offering a different approach for those who haven't responded to traditional therapies. ^{1 2 6 7 8}

What is the purpose of this trial?

This project will evaluate the effects of bilateral knee pain and dry needling (DN) on laterality recognition, movement and muscle function. The objective is to determine if laterality recognition accuracy deficits are present in individuals with bilateral chronic knee pain and if DN affects 'central' and 'peripheral' musculoskeletal measurements. Chronic musculoskeletal pain results in changes to the way the brain perceives pain and left-right discrimination between body parts. This phenomenon has been established for individuals with chronic back pain and chronic regional pain syndrome, but has not been described for individuals with bilateral knee pain without the presence of knee OA. Dry needling involves the insertion of a small diameter monofilament needle into muscle, and has been purported to affect the neuromuscular system both centrally and peripherally. Sixty individuals between 18 and 40 years old will be recruited and allocated into three groups. The first group will consist of 20 subjects presenting with bilateral chronic anterior knee pain and high fear of movement with scores on Tampa Kinesiophobia Scale (fear of movement) greater than 37. The second group with consist of 20 subjects with bilateral chronic anterior knee pain and low fear of movement between ages of 18 and 40 years old, and the third group will consist of healthy controls without knee pain between 18 and 40 years old. All subjects will undergo baseline testing consisting of laterality recognition, movement analysis, muscle force production, and ultrasound imaging. Subjects will undergo laterality recognition testing using the Neuro Orthopaedic Institute (NOI) Recognise Knee phone application. 2D video analysis of the lateral step down test will be performed followed by peak isometric force production assessment of knee extension and flexion. Muscle function of the vastus medialis will be measured with ultrasound imaging where cross-sectional area and other measurements (tendon length, muscle thickness, etc) will be captured with Lumify ultrasound imaging transducer. Then DN to the quadriceps will be performed. After DN procedure, subjects will undergo aforementioned measurements from baseline testing. Testing will require only one appointment by the subject, which will last approximately 2 hours an include baseline testing, dry needling, and post testing. No follow up will occur afterwards.

Research Team

Matthew S Briggs, DPT, PhD

Principal Investigator

Ohio State University

Eligibility Criteria

This trial is for people aged 18-40 with chronic knee pain, divided into groups based on their fear of movement. One group has high fear (Tampa Scale >37), one has low fear (Tampa Scale <37), and a control group without knee pain. Participants should not have had recent knee surgery, be pregnant, or have neurological issues affecting movement.

Inclusion Criteria

I am 18-40, have had knee pain for 3+ months, low fear of movement, and no knee arthritis.

I am 18-40, have had knee pain for 3+ months, am very afraid of moving in case it causes injury, my knee pain is severe, and I don't have knee arthritis.

Exclusion Criteria

I have an injury to my meniscus, cartilage, or ligaments.

I have a condition that impacts my ability to move.

I have had knee surgery within the last 6 months.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

Baseline Testing

Participants undergo baseline testing including laterality recognition, movement analysis, muscle force production, and ultrasound imaging

45 minutes

1 visit (in-person)

Dry Needling

Dry needling procedure performed on quadriceps muscle

15 minutes

1 visit (in-person)

Post Testing

Participants undergo post testing including laterality recognition, movement analysis, muscle force production, and ultrasound imaging

45 minutes

1 visit (in-person)

Follow-up

Participants are monitored for immediate effects after dry needling

5 minutes

Treatment Details

Interventions

• Dry Needling

Trial Overview The study tests if dry needling can improve brain perception related to pain and body part discrimination in those with bilateral knee pain. It involves baseline testing using an app and muscle function analysis, followed by dry needling treatment, then retesting—all within a single two-hour session.

Participant Groups

Group I: Bilateral Patellofemoral Pain with Low Fear of Movement Experimental Treatment 1 Intervention

The second group with consist of 20 subjects with bilateral chronic anterior knee pain and low fear of movement between ages of 18 and 40 years old.

Group II: Bilateral Patellofemoral Pain with Fear of Movement Experimental Treatment 1 Intervention

The first group will consist of 20 subjects presenting with bilateral chronic anterior knee pain and high fear of movement with scores on Tampa Kinesiophobia Scale (fear of movement) greater than 37.

Group III: Healthy controls without knee pain Active Control 1 Intervention

The third group will consist of healthy controls without knee pain between 18 and 40 years old.

Dry Needling is already approved in United Kingdom, United States for the following indications:

Approved in United Kingdom as Dry Needling for:

• Knee osteoarthritis pain management
• Muscle strength improvement
• Leg function enhancement

Approved in United States as Dry Needling for:

• Chronic knee pain relief
• Musculoskeletal pain management
• Myofascial pain syndrome treatment

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

Findings from Research

Trigger point dry needling shows a moderate effect in reducing pain and improving disability in individuals with patellofemoral pain, based on a meta-analysis of 10 studies involving various knee pain conditions.

While dry needling was effective in the short term, no significant benefits were observed for knee osteoarthritis or post-surgery knee pain, and further high-quality research is needed to assess long-term effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis. Rahou-El-Bachiri, Y., Navarro-Santana, MJ., Gómez-Chiguano, GF., et al.[2020]

In a study of 54 patients with patellofemoral pain syndrome, both ischaemic compression and dry needling showed significant improvements in pain, functional status, and sensitivity to mechanical stimulation over a 3-month follow-up period.

There were no significant differences in effectiveness between the two treatment methods, suggesting that both techniques can be considered equally effective for managing symptoms of patellofemoral pain syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial. Behrangrad, S., Abbaszadeh-Amirdehi, M., Kordi Yoosefinejad, A., et al.[2021]

A study involving 40 subjects found that dry needling of myofascial trigger points before total knee arthroplasty significantly reduced pain in the first month post-surgery compared to a placebo group.

The dry needling group also required fewer immediate analgesics after surgery, indicating its effectiveness in managing acute postoperative pain, although the benefits were not sustained at 3 and 6 months follow-up.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Mayoral, O., Salvat, I., Martín, MT., et al.[2022]

Dry needling (DN) significantly reduced muscle activity and pain in the upper trapezius muscle of participants with latent trigger points, as shown by lower surface electromyography (sEMG) readings compared to a sham treatment.

Participants receiving DN also experienced a higher pressure pain threshold (PPT) at 72 hours post-treatment, indicating improved pain tolerance compared to those in the sham group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in electromyographic activity of latent trigger points after a dry needling intervention: a randomised controlled trial. Sánchez-Infante, J., Bravo-Sánchez, A., Esteban-García, P., et al.[2022]

Dry needling (DN) significantly improved pain intensity and pressure pain threshold (PPT) in patients with myofascial trigger points in the upper trapezius muscle, showing greater benefits 48 hours after treatment compared to immediate effects.

In contrast, ischemic compression (IC) was more effective immediately after treatment for PPT, but did not show significant improvement in pain intensity over time, highlighting the delayed efficacy of DN.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Effectiveness of Dry Needling Immediately After Application on Myofascial Trigger Point in Upper Trapezius Muscle. Ziaeifar, M., Arab, AM., Nourbakhsh, MR.[2022]

In a study involving nine rabbits, dry needling of myofascial trigger points significantly reduced spontaneous electrical activity (SEA) in the treated muscle, indicating its effectiveness in relieving myofascial pain.

The results suggest that eliciting local twitch responses during dry needling is crucial for reducing SEA, highlighting that this response, rather than just the needling itself, plays a key role in the treatment's efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Chen, JT., Chung, KC., Hou, CR., et al.[2019]

In a case series of 14 patients with persistent pain after total knee arthroplasty, a combined treatment of dry needling and therapeutic exercise resulted in a significant reduction in pain intensity and improvements in function and range of motion over 4 weeks.

Patients experienced a decrease in pain scores from an average of 55.6 to 19.3 and improved knee flexion from 82.7° to 93.3°, indicating that this treatment approach may be effective for managing chronic postsurgical pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series. Núñez-Cortés, R., Cruz-Montecinos, C., Vásquez-Rosel, Á., et al.[2022]

In a study involving 40 female patients with mild to moderate knee osteoarthritis, three sessions of dry needling significantly improved pain, sensitivity, balance, and function compared to a sham treatment.

The results indicate that dry needling is an effective short-term intervention for enhancing functional activity and reducing pain in knee osteoarthritis patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. Farazdaghi, M., Kordi Yoosefinejad, A., Abdollahian, N., et al.[2021]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Changes in electromyographic activity of latent trigger points after a dry needling intervention: a randomised controlled trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Clinical Effectiveness of Dry Needling Immediately After Application on Myofascial Trigger Point in Upper Trapezius Muscle. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. [2021]