Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis.

OBJECTIVE: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between the number of MTrPs and pain and function in patients presenting knee pain osteoarthritis (OA). METHODS: This was a secondary analysis of data from a cross-sectional study. The prevalence of MTrPs located in tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles was studied in 114 patients (71 men and 43 women) with knee OA. Pain and functionality were assessed with a numerical pain rating scale (NPRS), the Western Ontario, McMaster Universities Osteoarthritis Index (WOMAC) score, the Barthel Index, and the timed up and go test. RESULTS: The prevalence of latent MTrPs was detected via palpation and was estimated to be 50%, 35%, 25%, 29%, 33%, and 12% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. The prevalence of active MTrPs was estimated to be 11%, 17%, 30%, 18%, 25%, and 17% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. Pain was measured with the NPRS scale and was poorly correlated with the prevalence of latent MTrPs (r = 0.2; p = 0.03) and active MTrPs (r = 0.23; p = 0.01) in the hamstrings. Disability was moderately correlated with the number of latent MTrPs in the tensor fasciae latae muscle (Barthel, r = 0.26; p = 0.01 and WOMAC, r = 0.19; p = 0.04). CONCLUSIONS: This secondary analysis found that the prevalence of the MTrPs varied from 11% to 50% in different muscles of patients with mild to moderate painful knee osteoarthritis. Pain was correlated poorly with the prevalence of latent and active MTrPs in the hamstring muscles, and disability correlated moderately with the number of latent MTrPs in tensor fasciae latae.

Is a Combination of Exercise and Dry Needling Effective for Knee OA?

OBJECTIVE: To assess the effectiveness of adding dry needling (DN) to an exercise program on pain intensity and disability in patients with knee osteoarthritis. DESIGN: Double-blind randomized clinical trial with one-year follow-up. SETTING: Older adults in a multicenter study. SUBJECTS: Sixty-two patients with knee osteoarthritis were randomly allocated into one of two groups: exercise plus DN (exercise + DN; N = 31) or exercise plus sham DN (exercise + sham DN; N = 31). METHODS: Participants received six sessions of either DN or sham DN over the leg muscles related to knee pain from osteoarthritis plus a supervised exercise program. We evaluated between-group differences in terms of the numerical pain rating scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. We used the EuroQol Group 5-Dimension Self-Report Questionnaire, Barthel Index, Timed Up & Go Test, and Global Rating of Change Scale to examine between-group differences for health-related quality of life, functional status evaluation, balance assessment, and clinical progress, respectively. RESULTS: The groups were not different in terms of pain intensity (0.32 points, 95% confidence interval [CI] = -1.12 to 1.18, P = 0.92) or WOMAC score (0.29 points, 95% CI = -6.16 to 6.74, P = 0.92) at one year. Both groups presented within-group differences at all follow-up periods (F = 28.349, P < 0.0001, ηp2 = 0.32) on secondary outcomes. Nevertheless, 90.3% of the DN group had reduced medication consumption vs only 26.3% in the sham DN group. CONCLUSIONS: The inclusion of DN to an exercise program does not reduce pain or disability in patients with knee osteoarthritis.

Clinical features and myofascial pain syndrome in older adults with knee osteoarthritis by sex and age distribution: A cross-sectional study.

BACKGROUND: A source of myofascial pain and myofascial trigger points (MTrPs) in muscles of the knee area could play a crucial role in the management of pain in osteoarthritis patients. The aim of this study was to describe and compare demographic, clinical and myofascial pain syndrome characteristics in older adults with knee osteoarthritis by sex and age distribution. METHODS: A cross-sectional study was carried out. 114 patients with osteoarthritis were recruited in older-adult care centers. The diagnosis of active and/or latent MTrPs (AMTrPs/LMTrPs) was performed. Numerical Pain Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Barthel Index, Timed Up and Go Test (TUG), Mini-Mental State Examination, EuroQol Group 5-Dimension Self-Report Questionnaire, chronicity, number of falls, and medication use were collected. All data were compared by sex (male or female) and age (< 70, 70-80, or > 80 years) distributions. RESULTS: The most prevalent muscles with AMTrPs and LMTrPs were the quadriceps vastus medialis (75.43%) and lateralis (65.78%), respectively. The clinical characteristics showed significant differences (P<0.05) for chronicity, WOMAC functionality and total scores, TUG, falls rate and medication between males and females, as well as for chronicity, Barthel index and TUG between age distributions. There were not any significant differences (P>0.05) by sex or age distribution according to the number and presence of active and latent MTrPs. CONCLUSIONS: The demographic and clinical features of older adults with knee osteoarthritis may be influenced by sex and age distribution. Nevertheless, the myofascial pain syndrome associated with knee osteoarthritis did not seem to be related to sex or age distribution.

Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial.

BACKGROUND: Few studies have investigated the dry needling (DN) approach on knee osteoarthritis (KO) patients. The study's aim was to evaluate the short-term efficacy of adding DN to a therapeutic exercise protocol in the treatment of KO in older adults. METHODS: A double-blind, pilot clinical trial with parallel groups [NCT02698072] was carried out for 12 weeks of treatment and follow-up. Twenty patients aged 65 years and older with myofascial trigger points (MTrPs) in the muscles of the thigh were recruited from older-adult care centers and randomly assigned to a DN + Exercise group or a Sham-DN + Exercise group. The Numeric Rating Scale (NRS; primary outcome) and Western Ontario and McMaster Universities Osteoarthritis Index questionnaire (WOMAC) were assessed before and after the intervention. RESULTS: The NRS (analysis of variance, ANOVA) showed statistically significant differences in the time factor (F = 53.038; P < .0001; ηp = 0.747). However, it did not show a significant change in the group-time interaction (F = 0.082; P = .777; ηp = 0.005). The WOMAC scores (ANOVA) showed statistically significant differences in the time factor for total score WOMAC questionnaire (F = 84.826; P < .0001; ηp = 0.825), WOMAC pain (F = 90.478; P < .0001; ηp = 0.834), WOMAC stiffness (F = 14.556; P < .001; ηp = 0.447), and WOMAC function (F = 70.872; P < .0001; ηp = 0.797). However, it did not show a statistically significant change in the group-time interaction. CONCLUSION: Despite the pain intensity and disability clinically relevant improvement for both DN and Sham-DN combined with exercise, 6 sessions of DN added to a therapeutic exercise program for older adults with KO did not seem to improve pain intensity and functionality.