The Effect of Dry Needling in Patients With Knee Osteoarthritis

The Effect of One Dry Needling Session on Pain and Central Pain Processing in Patients With Knee Osteoarthritis: a Randomized Controlled Trial

Research suggests that myofascial trigger points (MTrP) play an important role in explaining pain in patients with musculoskeletal knee disorders. Trigger points are usually defined as hypersensitive tender spots within taut bands of skeletal muscles that are painful on muscle stimulation and that usually elicit referred pain. Treatment of these trigger points could possibly alleviate symptoms in patients with knee pain. However, literature on the effect of trigger point therapy, dry needling in particular, in patients with musculoskeletal knee disorders is scarce. The purpose of this study is to examine the effect of trigger point therapy (dry needling (DN)) on pain, presence of altered central pain processing, muscle features and gait pattern in patients with knee osteoarthritis (KOA). 60 patients with symptomatic KOA will participate in this study. They will randomly be allocated in either an experimental group (EG) (dry needling technique) or a placebo group (PG) (sham needling technique). Pain (Visual analogue scale (VAS) & KOA outcome score (KOOS), muscle features during gait and gait pattern (3D gait analysis and surface electroMyoGraphy (EMG)) and presence of altered central pain processing (Central Sensitization Inventory (CSI), Quantitative Sensory testing (QST)) will be measured at baseline and 15 minutes after the intervention. Additionally, pain will be measured 3 days after the intervention. The investigators hypothesize that the effect on the outcome measures will be significantly larger in the EG compared to the PG.

Study Overview

• Status: Completed
• Conditions: Osteoarthritis, Knee
• Intervention / Treatment: Other: Dry Needling; Other: Sham Needling

• Study Type: Interventional
• Enrollment (Actual): 61
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 46 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• A minimum age of fifty years old;

• Diagnosed with KOA based on the American College of Rheumatology (ACR) clinical classification criteria(48), including:

  • A Kellgren-Lawrence grade of minimum two on radiography;
  • At least three months of chronical knee pain.

Exclusion Criteria:

• Patients suffering from autoimmune and/or neurological disorders
• Patients who had a major trauma/fracture of the lower limb in the past six months -
• Patients who experienced other musculoskeletal problems than OA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DN group; All identified MTrPs were inserted with a sterile filiform needle (0,30mm x 40mm or 0,30mm x 75mm, depending on the muscle) that moved up- and downwards until a local twitch response was elicited. When the repeated local twitch response fade away or the subject reported too much pain, the needle was removed. After the treatment, a 15 minutes break(51) was set up and the subjects were not permitted to use a hot pack or to stretch the muscle.	Other: Dry Needling
Sham Comparator: Sham needling (SN) group; The SN technique was similar to DN, except for penetrating the muscle. In this technique, the needle only penetrated the skin and was therefore impossible to provoke a local twitch response.	Other: Sham Needling

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain sensation	Measured with a Visual Analogue Scale, scored from 0 to 100, where higher scores indicate higher pain sensation.	Change from baseline pain sensation at 15minutes postintervention
Pain sensation	Measured with the Knee Osteoarthritis Outcome Score- subscale pain, scored on a scale from 0 to 36, transferred from 0 to 100. Higher scores indicate a higher pain sensation.	Change from baseline pain sensation at 15minutes postintervention
Pain sensation	Measured with a Visual Analogue Scale, scored from 0 to 100, where higher scores indicate higher pain sensation.	Change from baseline pain sensation at 3days postintervention
Pain sensation	Measured with the Knee Osteoarthritis Outcome Score- subscale pain, scored on a scale from 0 to 36, transferred from 0 to 100. Higher scores indicate a higher pain sensation.	Change from baseline pain sensation at 3days postintervention
Pain sensation	Measured with a Visual Analogue Scale, scored from 0 to 100, where higher scores indicate higher pain sensation.	Change from 15minutes postintervention pain sensation at 3days postintervention
Pain sensation	Measured with the Knee Osteoarthritis Outcome Score- subscale pain, scored on a scale from 0 to 36, transferred from 0 to 100. Higher scores indicate a higher pain sensation.	Change from 15minutes postintervention pain sensation at 3days postintervention
Pain pressure thresholds	Measured with an digital algometer (kilogram force/ square cm)	Change from baseline central pain processing at 15minutes postintervention
Temporal summation	Measured with an digital algometer (kilogram force/ square cm)	Change from baseline central pain processing at 15minutes postintervention
Conditioned pain modulation	Measured with an digital algometer (test stimulus) and an inflatable cuff (conditioning stimulus). (kilogram force/ square cm)	Change from baseline central pain processing at 15minutes postintervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle coactivation of musculus Vastus medialis and musculus Semitendinosus	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Muscle coactivation of musculus Vastus medialis and musculus Biceps femoris	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Muscle coactivation of musculus Vastus lateralis and musculus Semitendinosus	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Muscle coactivation of musculus Vastus lateralis and musculus Biceps femoris	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius medialis	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius lateralis	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.	Change from baseline muscle coactivation at 15minutes postintervention
Stride time (seconds)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention
Stride length (meters)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention
Step time (meters/second)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention
Stance phase (%)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention
Step length (meters)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention
Step width (meters)	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.	Change from baseline muscle coactivation at 15minutes postintervention

Collaborators and Investigators

• Sponsor: Universiteit Antwerpen
• Investigators: Principal Investigator: Sophie Vervullens, Universiteit Antwerpen

Publications and helpful links

General Publications

• Vervullens S, Meert L, Baert I, Delrue N, Heusdens CHW, Hallemans A, Van Criekinge T, Smeets RJEM, De Meulemeester K. The effect of one dry needling session on pain, central pain processing, muscle co-contraction and gait characteristics in patients with knee osteoarthritis: a randomized controlled trial. Scand J Pain. 2021 Sep 30;22(2):396-409. doi: 10.1515/sjpain-2021-0091. Print 2022 Apr 26.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2016
• Primary Completion (Actual): April 1, 2019
• Study Completion (Actual): April 1, 2019

Study Registration Dates

• First Submitted: January 13, 2021
• First Submitted That Met QC Criteria: January 18, 2021
• First Posted (Actual): January 20, 2021

Study Record Updates

• Last Update Posted (Actual): January 20, 2021
• Last Update Submitted That Met QC Criteria: January 18, 2021
• Last Verified: January 1, 2021

More Information

Terms related to this study

• Keywords: pain; dry needling; central pain processing; EMG measurements; muscle coactivation; gait pattern
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: B3000201630444

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No