Ryodoraku Medicine and Stimulus Therapy
Vol.1: 33 - 35 ,2018

iARMS
Clinical Report
Ryodoraku Medicine and Stimulus Therapy is an International,
peer-reviewed scientific journalthat publishes original article inexperimental and clinical medicine for Ryodoraku Medicine

A Case Study: Immediate Effects of Dry Needling with Direct
Current on a Patient with Anterior Knee Pain

Yiu Ming WONG Ph.D.

Health Science Unit (PEC),
Hong Kong Physically Handicapped & Able Bodied Association,
Hong Kong

Official Journal of International
Association of Ryodoraku Medical Science（社）国際良導絡医学会雑誌

Abstract
Anterior knee pain could be caused by excessive lateral patellar displacement rooted fromover-activation of vastus lateralis. In this prospective observational case study, the effectiveness of
dry needling with direct current in a male adult with anterior knee pain was documented withsurface electromyography and magnetic resonance images. After a single-session treatment, acomparison between pre- and post-treatment electromyographic data and medical images revealed
that the muscle tension and lateral patellar displacement were reduced; those biomechanicalchanges likely contributed to a decrease on the numeric pain rating scale reported by the patient.
The positive finding in the present case warrants further investigation.

I. Introduction
The anterior knee pain affects approximately 25% of the population at some stage of
their lives; if the pain is chronic that can be adisabling condition and can drastically limits
daily activities. Excessive lateral patellar
displacement, associated with over-activationof vastus lateralis or weakness of vastus medialis, has been long regarded as one of thecausing factors 1). The displacement can leadto strain on the retro-patellar subchondralbone during movements (Figure 1), thus it isalso named as lateral patellar compression
syndrome (LPCS) 2). The present paper illustrates a patient with LCPS treated by dry
needling with direct current and relevant
immediate physiological effects.

Figure 1: Lateral patellar compression syndrome

33
Official Journal of International Association of Ryodoraku Medical Science（社）国際良導絡医学会雑誌

Ryodoraku Medicine and Stimulus Therapy
Vol.1: 33 - 35 ,2018

II. Clinical case
Patient:
A 29-year-old male, amateur soccer playerfor 4 years.
Complaint:
Right anterior knee pain for the past 8months which was aggravated by squat orrunning. Recently he retained from sport activates due to the pain.

c. Magnetic resonance imaging (MRI):MRI (Magneton Avanto 1.5T, Siemens
Medical Solutions, Inc., USA) was used toscan the affected knee and determine thedegree of lateral patellofemoral displacement in supine lying position. The patient
was asked to isometrically contract thequadriceps and worked against his own
lower-leg weight for 60 seconds while theknee flexion angle was 15-degree. The MRI
revealed the presence of lateral patellar
displacement (Figure 3A) 4).

Diagnosis:
LPCS, right side. No other medical conditions.
1. Pre-treatment evaluations:a. Surface electromyography (EMG):
Two surface EMG electrodes (Flexcomp,Thought Technology Ltd., Canada) wereplaced on the distal portion of vastus medialis and lateralis muscles for detecting
the electrical signal of muscular activities
while the patient performed right single-leg isometric squat at 45-degree knee
flexion for 10 seconds (Figure 2). The collected EMG data indicated that the average EMG signal was 153 micro-volts forthe vastus medialis and 231 micro-volts
for the vastus lateralis. This implies thatthe vastus lateralis was relatively overactive 1,3).
b. Numeric pain rating scale:
The knee pain during the above isometric squat, the score was 5/10 before treatment.

Figure 3: A = pre-treatment. B = post-treatment.
Dash-lines were used to illustrate the relative patellar positions. Both A and B shown the lateral patellar
displacement, but the B is of less severe.

2. Treatment:
The patient was treated using three acupuncture needles (L-type needle, gauge 3,Seirin Corporation, Japan) inserted 2-cm
deep into the vastus lateralis at points
F612-14, a direct current of 12 volts and 200
micro-amperes was applied for 30 seconds foreach needle using a Ryodoraku device(ES-160, ITO Co. Ltd., Japan) .
3. Post-treatment evaluations:
Immediately after the treatment, surface
EMG and MRI were repeated in order to detect possible changes induced by the needling.
a. Surface EMG: The average EMG signal
was 164 micro-volts for the vastus medialis
and 187 micro-volts for the vastus lateralis.
This means the vastus lateralis was lesstense after the treatment.

Figure 2: Surface EMG for vastus muscles

34
Official Journal of International Association of Ryodoraku Medical Science（社）国際良導絡医学会雑誌

Ryodoraku Medicine and Stimulus Therapy
Vol.1: 33 - 35 ,2018

b. Numeric pain rating scale: The score forright knee decreased from 5/10 to 1/10 after the treatment.
c. MRI: The figure 3B indicated that the patellar position was less laterally displaced
after the treatment.
III. Discussion
Based on the above, the lowered muscular
activation of the vastus lateralis likely contributed to the improved patellar position after treatment, then the more optimal patellofemoral joint contact led to reduced intra-articular pressure as well as the knee pain.
We propose that the over-activation of vastus
lateralis may be caused by improper functionof motor end plates with an excessive releaseof acetylcholine, and the needling with direct
current may damage the motor endplates in acontrolled manner. The damage may suppress
motor endplate activity, such as depleting
acetylcholine levels, thus reduce the muscle
tension of vastus lateralis 5).
There are limitations in the present study,
firstly it did not include a long term follow-up
for the patient, thus cannot confirm how long
the therapeutic effects can last. Also, a possibility cannot be ruled out which the vastus
lateralis adapts to the needling over time as
the recognized EMG and MRI observations
may change with repeated treatments.

References
1. Waryasz GR, McDermott AY.
Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors.
Dynamic Medicine, 26, 7, 9, 2008
2. Saper M.G., Shneider D.A.
Diagnosis and treatment of lateral patellar compression syndrome.
Arthroscopy Techniques, 3, e633-e638, 2014
3. De Meulemeester K, Calders P, Cagnie B.
EMG activity before, during and after dry needling of the upper trapezius muscle: preliminaryresults.
Manual Therapy, 25, e126-e127, 2016
4. Nicolaas L, Tigchelaar S, Koëter S.
Patellofemoral evaluation with magnetic resonance imaging in 51 knees of asymptomatic subjects.
Knee Surgery, Sports Traumatology, Arthroscopy,
19, 1735–1739, 2011
5. Cagnie B, Dewitte V, Barbe T, Timmermans F,Delrue N, Meeus M.
Physiologic effects of dry needling.
Current Pain and Headache Reports, 17, 348,
2013

IV. Conclusuion
The observations in the present case study
point to clinically relevant beneficial effects ofdry needling with direct current in a patientwith LPCS and warrant further investigation.
Acknowledgement
The author is very grateful to Ms. Rie
AZUMA who provided Japanese translation
for this article.

35
Official Journal of International Association of Ryodoraku Medical Science（社）国際良導絡医学会雑誌