Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial

Jaime Salom-Moreno, Blanca Ayuso-Casado, Beatriz Tamaral-Costa, Zacarías Sánchez-Milá, César Fernández-de-Las-Peñas, Francisco Alburquerque-Sendín, Jaime Salom-Moreno, Blanca Ayuso-Casado, Beatriz Tamaral-Costa, Zacarías Sánchez-Milá, César Fernández-de-Las-Peñas, Francisco Alburquerque-Sendín

Abstract

Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

Figures

Figure 1
Figure 1
Closed kinetic chain exercises on stable surface: (a) bilateral semisquats; (b) one leg standing exercise.
Figure 2
Figure 2
One leg standing exercise on unstable surface.
Figure 3
Figure 3
One leg standing exercise on unstable surface including perturbation training by the therapist.
Figure 4
Figure 4
Trigger point dry needling (TrP-DN) applied over the lateral peroneus muscle. With the patient in side-lying position, the needle was inserted into the skin over the TrP until the first local twitch response was obtained and moved up and down (2 to 3 mm vertical motions with no rotations) at approximately 1 Hz for 25–30 seconds.
Figure 5
Figure 5
Flow diagram of patients throughout the course of the study.

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