Comparison of INIT and Dry Needling on Trigger Points in Knee OA

The purpose of the study is to compare the effects of Integrated Neuromuscular Inhibition Technique and Dry Needling on Functional Disability, Pain and Range of Motion. A randomized control trial will be conducted at Wah General Hospital Taxila. The sample size is 36 calculated through G-Power but I recruited 50. The participants were divided into two interventional groups each having 18 participants. Tools used in this study are Goniometer, NPRS, WOMAC, and Self structured Questionnaire. Data will be collected before and immediately after the application of interventions. Data will be analyzed through SPSS.

Knee osteoarthritis (OA) is also known as degenerative joint disease, in which there is progressive loss of articular cartilage due to wear and tear. Knee osteoarthritis can be classified into two types, primary and secondary. Primary osteoarthritis is defined as degeneration of articular cartilage without any underlying cause. Secondary osteoarthritis can be caused due to either an abnormal amount of forces placed across the joint in a result of post-traumatic cause or due to abnormal articular cartilage, for example Rheumatoid arthritis. The prevalence of knee OA is higher as compared to other types of OA. As with increasing age and longer lifetime and higher average weight of population the incidence of knee OA increases, particularly in obese women. Women have a greater prevalence (42.1%) than do men (31.2%). There are different grades of knee OA. In Grade 1 There is a swelling of articular cartilage along with mild fibrillation in superficial zone. In Grade 2 Small portion of cartilage is lost and fibrillation occurs in deeper zone and clusters of chondrocytes begun to form. In Grade 3 formation of chondrons occurs and vertical fissures have advanced into middle zone. Early OA changes affects the superficial and middle zone of cartilage. There are different risk factors for developing Knee OA that includes age, Female Gender, Menopause, heredity, repetitive micro and macro trauma, alcohol and tobacco use and joint surgery. Some risk factors are modifiable and some are non-modifiable. Modifiable factors include: any trauma, occupation, weight, muscle weakness or imbalance, Prolonged standing and repetitive knee bending. Non-modifiable risk factors include Gender - females, Age, Genetics and Race. There can be different causes of knee OA including family history, obesity, age, diabetes, systemic inflammatory mediators, lower limb alignment, trauma and inflammation by metabolic syndrome. Diagnosis of Knee OA is mainly based on symptoms and X-rays according to Kellgren and Lawrence system for classification of Osteoarthritis. The Knee OA most common symptom is pain around knee joint, Pain can be of different nature such as dull, intermittent or sharp. Pain intensity can also vary from mild to moderate to severe. The Range of motion can also be decreased in knee OA. Other symptoms include grinding and popping sounds. Swelling, locking and giving way of the knee can also be seen in later stages. Inconsistencies are observed, in which they explain presence of Myofascial trigger points in surrounding muscles around knee. Studies showed treatment of trigger points will cause reduction in pain and improvement in functional capacity in Knee OA patients. There are different techniques to treat trigger points e.g. Dry needling and Integrated neuromuscular inhibition technique.

Study reported that there's significant reduction in pain and disability along with improved ROM in Knee Osteoarthritis patients who received Integrated Neuromuscular Inhibition Technique combined with Conventional treatment.

Another study conducted on Effect of Integrated Neuromuscular Inhibition Technique on Iliotibial Band Tightness in Osteoarthritis of Knee and their study concluded that there is a significant effect of Integrated Neuromuscular Inhibition Technique on iliotibial band tightness in osteoarthritis of knee.

Study was done to check effect of Dry needling in an exercise program for older adults with knee OA, The study concluded Despite the pain intensity and disability clinically relevant improvement for both DN and Sham-DN combined with exercise, 6 sessions of DN added to a therapeutic exercise program for older adults with KO did not seem to improve pain intensity and functionality.

Study conducted on Dry needling versus INIT on upper trapezius myofascial trigger points. According to study findings DN was more effective than INIT on management of upper trapezius active myofascial trigger points.

Proper evidence behind comparative effect of INIT and DN on trigger points in knee OA patient is sparse and there are less number of studies with limited methodological design on these techniques. This study will contribute to compare the ef-fects of INIT and Dry Needling on Functional Disability, Pain and ROM in patients with knee OA, and to check whether which technique is more effective in treating trigger points in Knee Osteoarthritis patients

Eligibility Criteria:
Inclusion Criteria:

Osteoarthritis Grade-1 to 2 Positive jump sign Vastus medialis(75.43%), Vastus laterals(65.78%), Gastrocnemius

Exclusion Criteria:

* Patient with history of RA or any autoimmune disorder Any systematic Illness Patient with Varicose vein Post traumatic, Post-Surgical and Post fractured