The Effect of Needle Placement on Muscle Stiffness, Gait, Balance, Pain and Functional Outcomes in Individuals With Injury to the Ankle and/or Hindfoot
Condition: Ankle and or Hindfoot Injury
MeSH terms: Wounds and Injuries
Study type: Interventional

Summary: 
      The purpose of this randomized controlled trial is to assess the effect of DN at either the
      site of the identified myofascial trigger point/s (MTrP) of in the same muscle, but away from
      the MTrP site/s in individuals with ankle and/or hindfoot injury. Assessments will be of
      self-reported outcomes, self-reported pain, gait, balance, muscle stiffness, and pain
      pressure threshold. The secondary purpose of this study is to determine the validity of dry
      needling specific muscles of the lower extremity based upon needle placement, location
      relative to anatomical structures and accuracy of needle placement in muscle using ultrasound
      imaging.
    

Detailed description: 
      Few studies have assessed the validity of needling muscles of the lower extremity. For
      muscles such as the tibialis posterior that are not easily accessible or directly palpable
      secondary to the deep anatomical position and due to the proximity of the tibial nerve and
      the posterior tibial artery within the deep compartment, examining accurate needle placement
      is clinically relevant. In addition, DN has been shown to be a beneficial management strategy
      for individuals with lower extremity condition; however, the investigators may be able to
      optimize these beneficial effects by performing DN on the MTrP versus other sites within the
      same muscle.

      If needling directly into the MTrP is more effective than needling away from the MTrP but
      into the same muscle, it is possible that the improved efficiency could help to optimize
      management of patients with injury to the ankle/hindfoot with less visits and potentially
      decreasing health care costs.
    

Intervention name(s): Dry Needling
Intervention type(s): Other
Intervention description(s): The dry-needling treatment will consist of inserting a sterile needle into 2-4 muscles of the participant either at the MTrP or 2 cm away from the MTrP, but within the same muscle. To assist in the reduction of infection risk and protection of the participants, the site will be cleaned with alcohol prior to treatment and investigators performing the needling treatment will wear gloves and handle needles using aseptic technique throughout the procedure. Each needle insertion will last approximately 5 seconds using a "pistoning" (in and out) technique.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Specific Aim 1: To evaluate if DN has an effect on muscle stiffness, gait, pain pressure threshold, and balance in individuals with injuries to the ankle and/or hindfoot.
The dependent variables for Aim1 are: muscle stiffness, plantar pressure, PPT, and balance. The independent variables for Aim1 are Group (MTrP needling versus away from the MTrP site) and Time. The primary aim will be examined using linear mixed modeling with any baseline differences between groups used as a co-variate. A separate model will be created for each dependent variable.
Specific Aim 2: To determine the validity of dry needling specific muscles of the lower extremity based upon needle placement, location relative to anatomical structures and accuracy of needle placement in muscle with in vivo ultrasound imaging.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: dry needling; muscle stiffness; ankle injury; hindfoot injury; plantar pressure