Comparison of INIT and Dry Needling on Trigger Points in Knee OA

NCT06437730 | Recruiting

• 1 other identifier: RiphahIU Iqra Iftikhar
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of the study is to compare the effects of Integrated Neuromuscular Inhibition Technique and Dry Needling on Functional Disability, Pain and Range of Motion. A randomized control trial will be conducted at Wah General Hospital Taxila. The sample size is 36 calculated through G-Power but I recruited 50. The participants were divided into two interventional groups each having 18 participants. Tools used in this study are Goniometer, NPRS, WOMAC, and Self structured Questionnaire. Data will be collected before and immediately after the application of interventions. Data will be analyzed through SPSS.

Conditions

Knee Osteoarthritis

Keywords

Trigger Points,; Knee Osteoarthritis,; Dry Needling,; Integrated Neuromuscular Inhibition Technique,

Outcome Measures

Primary Outcomes (4)

• Western Ontario and McMaster Universities Arthritis Index

  The WOMAC pain score is a numerical score that measures pain, stiffness, and functional limitations. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for pain, 0-8 for stiffness, and 0-68 for physical function.

  6th day

• Numeric Pain Rating Scale

  The numeric pain rating scale is a scale for self-report of pain intensity. It is an 11-point scale, where 0 means no pain and 10 means the worst possible pain.

  6th day

• Goniometer:

  A goniometer is a device used in physical therapy to measure a joint's range of motion. It is essentially a protractor with two arms extending from it, used to measure a joint's range of motion.. There are two "arms" one that is stationary and one that is movable-that are hinged together. Each is positioned at specific points on the body with the center of the goniometer aligned at the joint of interest. The goniometer can be used to measure many joints such as the knee, hip, shoulder, or wrist.

  6th day

• Kellgren and Lawrence system for classification of Osteoarthritis:

  It is a common method of classifying the severity of Osteoarthritis using five grades The grades are as follows: Grade 0 (none): definite absence of x-ray changes of osteoarthritis Grade 1 (doubtful): doubtful joint space narrowing and possible osteophytic lipping Grade 2 (minimal): definite osteophytes and possible joint space narrowing Grade 3 (moderate): moderate multiple osteophytes, definite narrowing of joint space and some sclerosis and possible deformity of bone ends Grade 4 (severe): large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone ends.

  6th day

Study Arms (2)

Group: 1

EXPERIMENTAL

MTrPs points will be released with ischemic compression, position of ease will be acquired, and in the last METs will be performed. Ischemic compression applied through thumb on trigger point present in any muscle around the knee joint.

Other: Integrated Neuromuscular Inhibition Technique:

Group: 2

EXPERIMENTAL

Dry needle will be targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'. 0.25x25mm needle is inserted.

Other: Dry needling:

Interventions

Integrated Neuromuscular Inhibition Technique: OTHER

MTrPs points will be released with ischemic compression, position of ease will be acquired, and in the last METs will be performed. Ischemic compression applied through thumb on trigger point present in any muscle around the knee joint. Compression will be increased gradually until first resistance will feel and maintained until it resolves, further increases then until no tissue resistance will be felt under thumb. This process is maintained for 30sec and repeated 3-5 times per session. Positional release technique: after applying pressure on trigger point, patient will acquire position of ease that is maintained for 20 sec whether its extension or flexion of knee. This process is repeated 3-5 times per session. Muscle Energy Technique will be applied on the muscle in which isometric contraction is maintained for 7-10sec against 20-25% strength. After completion of muscular contraction, the limb is moved away for muscular stretch and then position is maintained for 30 seconds

Group: 1

Dry needling: OTHER

Dry needle will be targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'. 0.25x25mm needle is inserted. For vastus laterals patient is supine line with knee extended performing an isometric quadriceps contraction, maintaining a clean technique by using gloves and performing an alcohol wipe down bracket the tissue to be treated and inserting needle with direct approach towards the femur, performing pistoning. For vastus medialis patient is supine line with 30 degrees of knee flexion. A headless 0.25x25mm needle fixed between the fingers of non-dominant hand and inserted perpendicularly to the MTrPs with metacarpophalangeal flexion extension of 1st and 2nd fingers of dominant hand. For Gastrocnemius patient is prone lying and bolstered supported slight knee bend, for the upper part anterior medial approach is used and center of muscle belly slight medial anterior approach is used.

Group: 2

Eligibility Criteria

• Age: 40 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Osteoarthritis Grade-1 to 2 Positive jump sign Vastus medialis(75.43%), Vastus laterals(65.78%), Gastrocnemius

You may not qualify if:

• Patient with history of RA or any autoimmune disorder Any systematic Illness Patient with Varicose vein Post traumatic, Post-Surgical and Post fractured

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Wah General Hospital,

Rawalpindi, Punjab Province, 44000, Pakistan

RECRUITING

Related Publications (11)

• Hsu H, Siwiec RM. Knee Osteoarthritis. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK507884/

  PMID: 29939661 BACKGROUND

• Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16-183. doi: 10.7812/TPP/16-183.

  PMID: 29035179 BACKGROUND

• Heidari B. Knee osteoarthritis diagnosis, treatment and associated factors of progression: part II. Caspian J Intern Med. 2011 Summer;2(3):249-55.

  PMID: 24049581 BACKGROUND

• Favero M, Ramonda R, Goldring MB, Goldring SR, Punzi L. Early knee osteoarthritis. RMD Open. 2015 Aug 15;1(Suppl 1):e000062. doi: 10.1136/rmdopen-2015-000062. eCollection 2015.

  PMID: 26557380 BACKGROUND

• Ejaz F, Safdar M, Ejaz H. Comparative Effectiveness of Integrated Neuromuscular Inhibition Technique Along with Conventional Treatment Vs Conventional Treatment Alone in Patients of Knee Osteoarthritis. Pakistan Journal of Medical & Health Sciences. 2023;17(01):859-.

  BACKGROUND

• Albin SR, Koppenhaver SL, MacDonald CW, Capoccia S, Ngo D, Phippen S, Pineda R, Wendlandt A, Hoffman LR. The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points. J Electromyogr Kinesiol. 2020 Dec;55:102479. doi: 10.1016/j.jelekin.2020.102479. Epub 2020 Oct 9.

  PMID: 33075711 BACKGROUND

• Muraja S, Markulinčić B. FRI0597-HPR The effect of physical therapy on functional status and synovial perfusion in patients with knee osteoarthritis. Annals of the Rheumatic Diseases. 2013;72(Suppl 3):A578-A.

  BACKGROUND

• Mayoral O, Salvat I, Martin MT, Martin S, Santiago J, Cotarelo J, Rodriguez C. Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med. 2013;2013:694941. doi: 10.1155/2013/694941. Epub 2013 Mar 27.

  PMID: 23606888 BACKGROUND

• Chavan SE, Shinde S. Effect of Integrated Neuromuscular Inhibition Technique on Iliotibial Band Tightness in Osteoarthritis of Knee

  BACKGROUND

• Sanchez-Romero EA, Pecos-Martin D, Calvo-Lobo C, Ochoa-Saez V, Burgos-Caballero V, Fernandez-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore). 2018 Jun;97(26):e11255. doi: 10.1097/MD.0000000000011255.

  PMID: 29952993 BACKGROUND

• Abdelaziz YM, Abulkasem ST, Yamny AA. Dry Needling Versus Integrated Neuromuscular Inhibition Technique on Upper Trapezius Myofascial Trigger Points. Egypt J Appl Sci. 2020;35:45-56.

  BACKGROUND

MeSH Terms

Conditions

Osteoarthritis, Knee

Interventions

Dry Needling

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Intervention Hierarchy (Ancestors)

Complementary Therapies; Therapeutics; Physical Therapy Modalities

Study Officials

• Lal Gul Khan, MScPT

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, PhD

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 26, 2024
• First Posted: May 31, 2024
• Study Start: October 12, 2023
• Primary Completion: June 15, 2024
• Study Completion: June 30, 2024
• Last Updated: May 31, 2024

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)