THE EFFECTIVENESS OF TRIGGER POINTS DRY NEEDLING IN THE QUADRICEPS MUSCLE ON PAIN INTENSITY AMONG PATELLOFEMORAL PAIN SYNDROME PATIENTS: A SYSTEMATIC REVIEW

Abstract

Background Patellofemoral pain syndrome (PFPS), a non-traumatic condition, is characterised by anterior knee pain and is frequently associated with functional activities. The quadriceps muscle plays a major role in the aetiology and progression of PFPS. The available evidence confirms the presence of overall quadriceps muscle weakness and activation delay in PFPS patients. Muscle activation is primarily affected by the presence of trigger points in the muscle. Systematic reviews of the effectiveness of trigger point dry needling (TDN) in mixed muscles or across multiple body regions are available; however, despite the quadriceps playing a significant role in the condition, to date, no studies have specifically addressed the effectiveness of the use of TDN on the quadriceps of patients with PFPS Objectives: To assess the effect of TDN of the quadriceps muscle on pain intensity among PFPS patients. Search method: Database PEDro, Medline, Web of Science, AMED, EMBASE, Scopus, and CINAHL were searched between 10th October and 20th October 2022. Selection criteria: Randomised control trials (RCT) that used the TDN technique on the quadriceps muscle in PFPS patients to measure its effect on pain intensity. Data collection and analysis: Two independent reviewers assessed the methodological quality of the included studies using the PEDro scale. Only one reviewer conducted the data extraction process using the JBI data extraction tool. Results: The review included six RCT studies of low-to-moderate quality which involved a total of 283 participants. All six studies showed statistically significant improvements in pain intensity level outcomes pre-post intervention across the quadriceps TDN intervention (p<0.05). Combined TDN with conventional physiotherapy treatments demonstrated a more significant effect than TDN alone for pain intensity (p<0.05). However, no statistically significant differences were detected between TDN and other physical therapy interventions such as manual therapy, Kinesio tape (KT) and ischemic compression (IC). Conclusion: Based on the low-to-moderate quality of evidence, TDN of the quadriceps muscle may improve pain intensity among PFPS patients over the short-term. It appears that combining the TDN technique in multimodal therapy is more effective for PFPS patients than using TDN alone. Furthermore, there is evidence to suggest that the TDN technique in the quadriceps of PFPS patients is not superior to manual therapy, IC or KT in terms of pain intensity; rather, TDN has a similar effect. The results of the current review, however, are based on heterogeneous studies which have methodological limitations. Further high-quality research with a standardised TDN application protocol is required to increase the homogeneity of the studies.