Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation

Needling trigger points for treating myofascial pain syndrome: A systematic review and meta-analysis

BACKGROUND

Myofascial pain syndrome (MPS) is a widespread musculoskeletal disorder characterized by myofascial trigger points. Needling trigger points is one of the most common therapeutic interventions to treat MPS. However, it is unclear whether needling trigger points is superior to other non-pharmacological interventions.

METHODS

Randomized clinical trials (RCTs) which compared the effectiveness of needling trigger points and other non-pharmacological therapies for treating MPS, were searched in the databases of PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang, VPCS, and Sinomed, from their inception to August 25th, 2024. Two independent reviewers extracted relevant data on study characteristics and assessed the risk of bias using the Cochrane Risk of Bias Tool.

RESULTS

Of the 1968 articles initially screened, 13 RCTs were included. Needling trigger points treatment were more efficacious than non-pharmacological therapies in reducing Visual Analog Scale (VAS) scores (MD = -1.32; 95 % CI = -1.84 to -0.81; P < 0.0001) and the Roland-Morris Disability Questionnaire (RMDQ) scores (MD = -2.77; 95 % CI = -3.58 to -1.97; P < 0.0001).

CONCLUSION

This systematic review has shown that needling trigger points could be a more effective option than other non-pharmacological therapies to improve the symptoms of MPS. Clinical trials of robust quality are required to promote further the evidence-based application of needling trigger points for MPS.

Efficacy of Fu's Subcutaneous Needling in Treating Soft Tissue Pain of Knee Osteoarthritis: A Randomized Clinical Trial

Purpose: Fu’s subcutaneous needling (FSN) is a new acupuncture technique that produces a long-lasting effect in soft-tissue injuries. In patients with degenerative knee osteoarthritis (OA), myofascial trigger points (MTrPs) are common in the lower-limb muscles. In this randomized clinical trial, we evaluated the immediate, 1-week and 2-week effectiveness of FSN therapy in the treatment of degenerative knee OA. Patients and methods: We randomly divided 32 patients with knee OA into the FSN group (mean age: 65.73 ± 6.79 years) or the transcutaneous electrical nerve stimulation (TENS) group (mean age: 62.81 ± 5.72 years). The pressure pain threshold (PPT) and tissue hardness (TH) of the muscle and tendon attachment sites, knee range of motion, and physical ability (average walking speed) were measured. The subjective pain intensity index, Western Ontario and McMaster Universities OA Index (WOMAC), and Lequesne index were used to determine the efficacy of FSN on MTrP-induced soft-tissue pain compared with that of TENS. Results: A significantly greater improvement in pain qualities in the VAS (p < 0.05) was found in the FSN group. Moreover, in muscle and tendon qualities (including PPT and TH), a significant difference in the PPT of the quadriceps muscle (p < 0.05) was also observed among the immediate treatments in the FSN group. As for the functional index questionnaire assessment, the FSN group exhibited significant improvements among the immediate, 1-week and 2-week efficacies in terms of WOMAC (p < 0.05) and Lequesne index scores (p < 0.05). Conclusion: FSN was effective in treating soft-tissue pain in degenerative knee OA in terms of alleviating pain, strengthening walking ability, and improving overall functional performance. Pain relief was the primary benefit of FSN and a significant correlation between pain relief and knee joint mobility improvement was found. Trial registration: ClinicalTrials.gov Protocol Registration and Results System (registration number: NCT04356651).

Clinicians' beliefs and attitudes to physical activity and exercise therapy as treatment for knee and/or hip osteoarthritis: a scoping review

OBJECTIVE

To explore clinicians' attitudes and beliefs about physical activity and exercise therapy as treatment for individuals with knee and/or hip osteoarthritis (OA).

METHOD

This was a scoping review, mapping available knowledge about the topic derived from qualitative research designs and methods. A comprehensive search of selected databases (MEDLINE, EMBASE; CINAHL; Web of Science) was conducted and data were analysed thematically.

RESULTS

Twelve articles met inclusion criteria. Thematic analysis identified three interrelated main themes: 1) Understandings of OA and its trajectory and management; 2) Attitudes to activity and exercise as part of OA management; 3) Clinicians' perceived knowledge of and expertise in OA management. Findings highlight that many clinicians involved in knee/hip OA management, particularly general practitioners and physiotherapists, perceive OA to be a low priority 'wear-and-tear' disease with expected progression of symptoms, making joint replacement surgery eventually inevitable. Further, many clinicians appear to lack knowledge about and interest in physical activity and exercise therapy in the management of knee/hip OA, and seem to show uncertainty about the effectiveness and safety of physical activity and exercise therapy on joint health.

CONCLUSION

Clinicians' attitudes and beliefs about physical activity and exercise therapy in OA seem to reflect an outdated narrative which describes OA as a wear-and-tear disease with inevitable disease progression to joint replacement surgery. Clinicians need to adopt a contemporary narrative, which accurately reflects current knowledge and evidence-based practice, thereby ensuring consistent utilisation of exercise therapy as first-line care as recommended in OA guidelines.

Rehabilitation protocol after osteotomy of the tibia and varus femur - Case study

The knee rehabilitation in the aquatic environment has been used to start the rehabilitation of the lower limb earlier and improve joint movements, as it reduces pain and allows for earlier weight loading. The aim of the study was to develop and describe the effects of a therapeutic exercise program in an aquatic environment, in a clinical case of osteotomy of the tibia and the varus femur. A 15-year-old girl, submitted to an osteotomy of the tibia and the varus femur, completed a therapeutic exercise program in aquatic environment for a total of 30 sessions (3 sessions/week of 60 min). The subject was evaluated in two moments (at the beginning and at the end of the intervention). The results showed an improvement in the various parameters evaluated (knee flexion: 66° vs. 125°, knee extension: −7° vs. −1°, and pain on movement: 6/10 vs. 0/10). We concluded the therapeutic exercise program in the aquatic environment used in this study had beneficial effects in the clinical case of tibial osteotomy and varus femur.