The Effects of Needling Therapies on Muscle Force Production: A Systematic Review and Meta-analysis.

BACKGROUND: Needling has been shown to decrease pain in the short term; however, its effects on muscle force production are unclear. OBJECTIVE: To evaluate the evidence regarding the comparative effects of needling on muscle force production. METHODS: In this systematic review, an electronic search was performed using key words related to needling. Methodological quality of articles was appraised and effect sizes were calculated. The strength of evidence was determined, and meta-analysis was performed when similar methods were used in studies for similar conditions. RESULTS: Twenty-one studies were included in this review, of which 9 were deemed to be of high quality (greater than 6/10 on the Physiotherapy Evidence Database [PEDro] scale), 11 of fair quality (5 to 6/10), and 1 of poor quality (less than 5/10). Three meta-analyses were performed. There was moderate strength of evidence and medium effect sizes for needling therapy to enhance force production in those with neck pain, and very low strength of evidence of no effect for individuals with nonspecific and postoperative shoulder pain and those with lateral epicondylalgia. Other studies not included in the 3 meta-analyses demonstrated no significant effect of needling on force production. These studies included individuals with carpal tunnel syndrome, knee osteoarthritis, ankle sprains, knee arthroscopy, or delayed-onset muscle soreness. CONCLUSION: The majority of studies suggest no effect of dry needling on force production. High-quality studies with adequate power that control for the placebo effect and follow accepted reporting standards could make valuable contributions to the literature. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42017080318). LEVEL OF EVIDENCE: Therapy, level 1a. J Orthop Sports Phys Ther 2019;49(3):154-170. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8270.

Changes in tibiofemoral contact forces during running in response to in-field gait retraining.

We evaluated the efficacy of an in-field gait retraining programme using mobile biofeedback to reduce cumulative and peak tibiofemoral loads during running. Thirty runners were randomised to either a retraining group or control group. Retrainers were asked to increase their step rate by 7.5% over preferred in response to real-time feedback provided by a wrist mounted running computer for 8 routine in-field runs. An inverse dynamics driven musculoskeletal model estimated total and medial tibiofemoral joint compartment contact forces. Peak and impulse per step total tibiofemoral contact forces were immediately reduced by 7.6% and 10.6%, respectively (P < 0.001). Similarly, medial tibiofemoral compartment peak and impulse per step tibiofemoral contact forces were reduced by 8.2% and 10.6%, respectively (P < 0.001). Interestingly, no changes were found in knee adduction moment measures. Post gait retraining, reductions in medial tibiofemoral compartment peak and impulse per step tibiofemoral contact force were still present (P < 0.01). At the 1-month post-retraining follow-up, these reductions remained (P < 0.05). With these per stance reductions in tibiofemoral contact forces in mind, cumulative tibiofemoral contact forces did not change due to the estimated increase in number of steps to run 1 km.