Osteoarthritis, Knee
Conditions
Keywords
dry needling, central pain processing, pain, EMG measurements, muscle coactivation, gait pattern
Brief summary
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.
Interventions
OTHERDry Needling
OTHERSham Needling
Sponsors
Universiteit Antwerpen
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
A double-blinded study was achieved by giving no information about the assigned intervention to the executive researchers; and only the same general explanation about the intervention type to the subjects (Appendix A). Moreover, subjects were prohibited to see the needling-intervention. The group allocation was solely known by the treating therapists and the independent researcher (IB).
Intervention model description
One group will receive dry needling session and one group will receive placebo treatment. A simple randomization on a website (www.randomizer.org) performed by a researcher (IB), independent from the executive researchers.
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain sensation | Change from baseline pain sensation at 15minutes postintervention | Measured with a Visual Analogue Scale, scored from 0 to 100, where higher scores indicate higher pain sensation. |
| Pain pressure thresholds | Change from baseline central pain processing at 15minutes postintervention | Measured with an digital algometer (kilogram force/ square cm) |
| Temporal summation | Change from baseline central pain processing at 15minutes postintervention | Measured with an digital algometer (kilogram force/ square cm) |
| Conditioned pain modulation | Change from baseline central pain processing at 15minutes postintervention | Measured with an digital algometer (test stimulus) and an inflatable cuff (conditioning stimulus). (kilogram force/ square cm) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius medialis | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
| Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius lateralis | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
| Stride time (seconds) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Stride length (meters) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Muscle coactivation of musculus Vastus lateralis and musculus Biceps femoris | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
| Stance phase (%) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Step length (meters) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Step width (meters) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Step time (meters/second) | Change from baseline muscle coactivation at 15minutes postintervention | measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis. |
| Muscle coactivation of musculus Vastus medialis and musculus Semitendinosus | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
| Muscle coactivation of musculus Vastus medialis and musculus Biceps femoris | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
| Muscle coactivation of musculus Vastus lateralis and musculus Semitendinosus | Change from baseline muscle coactivation at 15minutes postintervention | 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. |
Outcome results
None listed