Dry Needling and Stretching vs. Stretching Alone on Hamstring Flexibility in Patients With Knee Pain
Condition: Mobility Limitation
MeSH terms: Mobility Limitation
Study type: Interventional

Summary: 
      The purposes of this double-blinded, randomized controlled trial are (1) to determine if the
      addition of trigger point dry needling (TDN) to a standard stretching program results in
      greater improvements in hamstring flexibility versus stretching alone in a population with
      atraumatic knee pain; (2) measure length of time that flexibility gains are maintained, (3)
      assess resulting movement mechanics and (4) assess patient reported changes in pain. Findings
      will potentially lead to insights as to the benefit of applying this intervention to
      additional body regions.
    

Detailed description: 
      In this study, up to 40 subjects with a history of atraumatic knee pain will be randomized
      into 2 groups of up to 20 subjects per group (1 experimental group and 1 control group).
      Subjects in the experimental group will receive TDN intervention with hamstring stretching
      while subjects in the control group will receive an alternative needling intervention with
      hamstring stretching. After meeting all inclusion criteria, all subjects will undergo the
      following tests: supine active knee extension, the active straight leg raise test, deep
      squat, and a single leg step down from a 6 inch step. Subjects who measure less than 20° from
      full extension on the active knee extension test will be excluded. Hamstring tightness has
      been operationally defined as having greater than 20° loss of knee extension as measured with
      the femur held at 90° of hip flexion.[1] Manual palpation of the bilateral biceps femoris,
      semitendinosus, and semimembranosus will be performed to detect the presence of myofascial
      trigger points (TPs) in groups 1 and 2. Dry needling will be performed to all detected TPs by
      a provider trained and experienced in TDN. Post TDN, all tests will be immediately repeated
      and at each follow up the subject will complete the Global Rating of Change survey (GROC) and
      Lower Extremity Functional Scale (LEFS).

      Post intervention, subjects in experimental group 1 will be given a standing hamstring
      stretch to perform 1 repetition held for 30 seconds, repeated 3 times daily. These parameters
      have been shown to be effective at improving flexibility.[2] Subjects will be instructed by
      demonstration and will be provided with a handout of stretching instructions. Subjects will
      be given an exercise log to record home exercise compliance.

      Subjects in group 2 will be given an alternative needling intervention followed by a standing
      hamstring stretch to perform 3 times per day, 1 repetition held for 30 seconds. Alternative
      needling intervention will be performed to give the appearance of regular TDN intervention;
      however, no needle penetration will be performed. Following alternative needling
      intervention, subjects will be instructed by demonstration and will be provided with a
      handout of hamstring stretching instructions. Home exercise compliance will be recorded at
      each follow up.

      Follow up measurements will be recorded between 1-2 days, 3-4 days, and 7-8 days post
      intervention. All tests will be repeated. One additional session of TDN and alternative
      needling intervention will be performed at day 3-4.
    

Intervention name(s): Dry Needling; Sham Needling
Intervention type(s): Procedure; Other
Intervention description(s): Trigger point dry needling to hamstring muscle group.; Superficial palpation of trigger point, skin is not punctured.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment