Manual Therapy and Dry Needling in Patellofemoral Syndrome
Condition: Patellofemoral Syndrome
MeSH terms: Patellofemoral Pain Syndrome; Syndrome
Study type: Interventional

Summary: 
      It is a randomized clinical trial comparing two treatments in patients affected by the
      patellofemoral syndrome (PFS). Our aim was to investigate the effectiveness of inclusion of
      trigger point dry needling into the management of idividuals with patellofemoral pain
      syndrome.
    

Detailed description: 
      Patients The sample involved patients diagnosed with nonspecific patellofemoral syndrome. The
      treatment is carried out at the School of Physiotherapy (University of Valencia).

      The study comprises patients with nonspecific patellofemoral syndrome. Patients excluded from
      the study are those with osteoarthritis, recent injuries, ligament injuries, meniscal
      lesions, previous injury and / or treatments lasting for a period of 6 months prior to the
      study.

      Study design It is a single-blind randomized controlled study. 3 sessions are conducted with
      7-day intervals and 15 days for the last intervention and follow-up at 3 months after
      treatment ended. Each session lasts approximately 30 minutes.

      The sample was divided into two groups:

        -  Control group with manual therapy and strengthening exercises for the quadriceps and
           hamstrings.

        -  Experimental group which receives manual therapy and strengthening exercises for the
           quadriceps and hamstrings combined with dry needling treatment (DN) in myofascial
           trigger points (MTrP) of vastus medialis and vastus lateralis of the quadriceps muscle
           and strengthening exercises for the quadriceps and hamstrings.

      Intervention Study treatment consists of a comprehensive joint treatment of the lumbar region
      and the lower limbs that are related to the biomechanics of the knee. In this way, the aim is
      to globally balance the possible dysfunctions that may exist in the lower lumbar region and
      sacroiliac joint, hip, knee and ankle.

      Assessment

      The initial assessment is a clinical interview with the characteristics of the patellofemoral
      syndrome for the month prior to the study and for this, the following assessment instruments
      are used:

        -  Intensity knee pain before the treatment is evaluated after treatment and monitoring.

        -  KOOS (Knee Injury and Osteoarthritis Outcome Score). It assesses five dimensions: pain,
           symptoms, activities of daily living, sport and recreational activity and quality of
           life related to the knee. To evaluate osteoarthritis in older patients, the 24 WOMAC
           questions are included.

        -  KSS (Knee Society Score). It is the modified scale of the American Knee Society. It
           makes it possible to separate the purely functional aspects of the knee joint, knee
           score, from those related to the patient's ability to walk and climb stairs, functional
           score.

      It includes three main parameters (pain, stability and range of motion) and other parameters
      (contraction of flexion, loss of extension and alignment) considered as deductions to score
      of the former, possibly presenting some interobserver variation.

      -IKDC (International Knee Documentation - Committee). It is an instrument to assess symptoms,
      function, and sport activity applicable to a variety of conditions of the knee. Validated for
      a variety of knee conditions including ligament, meniscal and articular cartilage injuries
      and also for osteoarthritis and patellofemoral pain.
    

Intervention name(s): Manual therapy; Dry needling
Intervention type(s): Other; Device
Intervention description(s): - Manual Therapy. Study treatment consists of a comprehensive joint treatment of the lumbar region and the lower limbs that are related to the biomechanics of the knee. In this way, the aim is to globally balance the possible dysfunctions that may exist in the lower lumbar region and sacroiliac joint, hip, knee and ankle.; Manual therapy. Study treatment consists of a comprehensive joint treatment of the lumbar region and the lower limbs that are related to the biomechanics of the knee. In this way, the aim is to globally balance the possible dysfunctions that may exist in the lower lumbar region and sacroiliac joint, hip, knee and ankle.
Dry needling (DN). Dry needling is performed in the MTrPs of the vastus lateralis and vastus medialis muscles of the quadriceps.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Trigger points; Manual therapy; Patellofemoral syndrome; Dry needling