This recent randomized, single blinded, clinical trial which was published in April 2017, seemed to report all of the pertinent details. They looked at relevant outcomes including pain intensity, range of motion (ROM), stability and functionality. The evaluator of the data was blinded to which intervention had been used. Consistent assessments were performed by a blinded assessor at baseline, 24 hrs, 1 week, and 5 weeks. Inclusion and exclusion criteria seems fair in that they only took 18-55 year old patients, all in the sub-acute post-surgical phase, all had unilateral reconstruction of a complete ACL rupture. Detailed exclusion criteria accounted for orthopedic and internal conditions which could influence results. Detailed descriptions of the two interventions were provided, in terms of rehabilitation (Rh) and a second group for rehabilitation with trigger point needling (Rh + TrPDN). Needling specifics including location, technique, size of needle and patient response in the form of a local twitch response (LTR) and sensation of pain, was provided. Treatment was performed by physical therapists with > 6 years experience and 30 hours per week of clinical practice. Three patients suffered from the adverse event of a hemorrhage >4cm2, one was lost to follow-up due to this adverse event. Shortcomings of the study were the small sample size of 44 patients, they did not track analgesic medication intake, the scale used to measure functionality in the Spanish speaking patients (WOMAC) was designed for knee osteoarthritis.
Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis.
The objective of this review, published in January 2017, was to assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS). Only RTC’s published in English and Chinese were included. A total of 847 relevant studies were identified, only 16 RCT’s met the inclusion criteria. Control groups included either sham/placebo or no intervention. Primary outcomes were pain intensity, measured by visual analogue scale or numerical rating scale, and pressure pain threshold (PPT). Secondary outcomes were adverse events and range of motion (ROM) at the neck. Patient population inclusion and exclusion criteria are clearly identified. A total of 477 patients were included in the 16 trials. Risk of bias assessment for each of the studies is included. The conclusion showed favorable results for pain relief and increased ROM. They recommend a course of treatment for 8 sessions, but acknowledge that more research should be done to determine the optimal number of treatments for individual conditions.
As a sports medicine practitioner, I often treat patients post-knee surgery for pain and weakness. I treat the vastus medialis with electro-acupuncture and prescribe exercises for strengthening this muscle. The meta-analysis stated that acupuncture when applied to muscle trigger points can activate the endogenous opioid system to induce an analgesic effect. I believe that anyone with an interest using acupuncture to treat pain instead of pharmaceuticals would be excited to see this information, along with the data showing increased ROM, decreased pain and increased pain pressure threshold. I often share both studies with patients, physical therapists and athletic trainers, so that they can understand my contribution to rehabilitation.
Velázquez-Saornil, J., Ruíz-Ruíz, B., Rodríguez-Sanz, D., Romero-Morales, C., López-López, D., & Calvo-Lobo, C. (2017). Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture. Medicine, 96(17), e6726. http://doi.org/10.1097/MD.0000000000006726
Wang R, Li X, Zhou S, et al Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis. Acupuncture in Medicine 2017;35:241-250.