Original Article: Effects of dry needling on pain in patients with knee osteoarthritis: A preliminary study


1 Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan

2 Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran


Background: Osteoarthritis is one of the most common rheumatological diseases and is also considered as one of the causes of myofascial trigger points (MtrPs). Dry needling (DN) is one of the methods used for the treatment of the MtrPs. The aim of the current study was to investigate the effects of DN on pain in participants with knee osteoarthritis (KOA). Materials and Methods: In this before and after preliminary clinical trial study, patients with mild to moderate KOA were enrolled. In one session, after determining the location of trigger points in quadriceps and gastrocnemius muscles, the patients underwent DN. The pain was evaluated at baseline, by passing 4 days and 1 month from the intervention using the Visual Analog Scale (VAS). Results: Sixteen patients with a mean age of 56.5 (4.53) years old have completed the study and follow-up period. According to the ANOVA analysis, VAS values indicated a significant decrease in pain score at the 4th and 1 month after the intervention compared to baseline (P < 0.001). There was no significant difference between VAS at the 4th day of intervention and also 1 month later of intervention (P = 0.087). Conclusion: The application of one session DN can lead to improvement in pain intensity in participants with mild to moderate KOA.


Ro DH, Lee J, Lee J, Park JY, Han HS, Lee MC. Effects of knee osteoarthritis on hip and ankle gait mechanics. Adv Orthop 2019;2019:9757369.  Back to cited text no. 1
Cunha JE, Barbosa GM, Castro PA, Luiz BLF, Silva AC, Russo TL, et al. Knee osteoarthritis induces atrophy and neuromuscular junction remodeling in the quadriceps and tibialis anterior muscles of rats. Sci Rep 2019;9:6366.  Back to cited text no. 2
Alburquerque-García A, Rodrigues-de-Souza DP, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis. J Manipulative Physiol Ther 2015;38:262-8.  Back to cited text no. 3
Shafizadegan Z, Karimi MT, Shafizadegan F, Rezaeian ZS. Evaluation of ground reaction forces in patients with various severities of knee osteoarthritis. J Mech Med Biol 2016;16:1650003.  Back to cited text no. 4
Rahou-El-Bachiri Y, Navarro-Santana MJ, Gómez-Chiguano GF, Cleland JA, López-de-Uralde-Villanueva I, Fernández-de-Las-Peñas C, et al. Effects of trigger point dry needling for the management of knee pain syndromes: A systematic review and meta-analysis. J Clin Med 2020;9:E2044.  Back to cited text no. 5
Sánchez Romero EA, Fernández Carnero J, Villafañe JH, Calvo-Lobo C, Ochoa Sáez V, Burgos Caballero V, et al. Prevalence of myofascial trigger points in patients with mild to moderate painful knee osteoarthritis: A secondary analysis. J Clin Med 2020;9:E2561.  Back to cited text no. 6
Ziaeifar M, Arab AM, Karimi N, Nourbakhsh MR. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther 2014;18:298-305.  Back to cited text no. 7
Dor A, Kalichman L. A myofascial component of pain in knee osteoarthritis. J Bodyw Mov Ther 2017;21:642-7.  Back to cited text no. 8
Henry R, Cahill CM, Wood G, Hroch J, Wilson R, Cupido T, et al. Myofascial pain in patients waitlisted for total knee arthroplasty. Pain Res Manag 2012;17:321-7.  Back to cited text no. 9
Ganesh GS, Singh H, Mushtaq S, Mohanty P, Pattnaik M. Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points. J Bodyw Mov Ther 2016;20:477-83.  Back to cited text no. 10
Rahbar M, Toopchizadeh V, Eftekharsadat B, Ganjeifar V. Therapeutic efficacy of myofascial trigger points therapy in patients with bilateral knee osteoarthritis (a randomized clinical trial). Life Sci J 2013;10:472-8.  Back to cited text no. 11
Unverzagt C, Berglund K, Thomas JJ. Dry needling for myofascial trigger point pain: A clinical commentary. Int J Sports Phys Ther 2015;10:402-18.  Back to cited text no. 12
Anandkumar S. Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A case report. Physiother Theory Pract 2018;34:157-64.  Back to cited text no. 13
Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther 2015;23:276-93.  Back to cited text no. 14
Itoh K, Saito S, Sahara S, Naitoh Y, Imai K, Kitakoji H. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: A preliminary study. J Acupunct Meridian Stud 2014;7:59-64.  Back to cited text no. 15
Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res 2016;474:1886-93.  Back to cited text no. 16
Tekin L, Akarsu S, Durmuş O, Cakar E, Dinçer U, Kıralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: A randomized double-blinded placebo-controlled trial. Clin Rheumatol 2013;32:309-15.  Back to cited text no. 17
Ortega-Cebrian S, Luchini N, Whiteley R. Dry needling: Effects on activation and passive mechanical properties of the quadriceps, pain and range during late stage rehabilitation of ACL reconstructed patients. Phys Ther Sport 2016;21:57-62.  Back to cited text no. 18
Rayegani SM, Bayat M, Bahrami MH, Raeissadat SA, Kargozar E. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clin Rheumatol 2014;33:859-64.  Back to cited text no. 19
Tabatabaiee A, Ebrahimi I, Ahmadi A, Sarrafzadeh J. Comparison between the effect of pressure release and dry needling on the treatment of latent trigger point of upper trapezius muscle. Phys Treat 2013;3:9-15.  Back to cited text no. 20
Sánchez Romero EA, Fernández-Carnero J, Calvo-Lobo C, Sáez VO, Caballero VB, Pecos-Martín D. Is a combination of exercise and dry needling effective for knee OA? Pain Med 2020;21:349-63.  Back to cited text no. 21
Gaudreault N, Mezghani N, Turcot K, Hagemeister N, Boivin K, de Guise JA. Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis. Clin Biomech (Bristol, Avon) 2011;26:284-91.  Back to cited text no. 22
Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: A randomized controlled trial. Clin Rehabil 2010;24:1091-101.  Back to cited text no. 23
Dunning J, Butts R, Young I, Mourad F, Galante V, Bliton P, et al. Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis: A multicenter randomized clinical trial. Clin J Pain 2018;34:1149-58.  Back to cited text no. 24
Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007;15 Suppl A: A1-56.  Back to cited text no. 25
Thorp LE, Sumner DR, Block JA, Moisio KC, Shott S, Wimmer MA. Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. Arthritis Rheum 2006;54:3842-9.  Back to cited text no. 26
Simons DG, Travell JG, Simons LS. Travell and Simons' Myofascial Pain and Dysfunction: Upper Half of Body. Philadelphia, PA: Lippincott Williams and Wilkins; 1999.  Back to cited text no. 27
Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points. J Bodyw Mov Ther 2017;21:48-52.  Back to cited text no. 28
Mayoral O, Salvat I, Martín MT, Martín S, Santiago J, Cotarelo J, et al. 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.  Back to cited text no. 29
Sánchez-Romero EA, Pecos-Martín D, Calvo-Lobo C, Ochoa-Sáez V, Burgos-Caballero V, Fernández-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore) 2018;97:e11255.  Back to cited text no. 30
Torres-Chica B, Núñez-Samper-Pizarroso C, Ortega-Santiago R, Cleland JA, Salom-Moreno J, Laguarta-Val S, et al. Trigger points and pressure pain hypersensitivity in people with postmeniscectomy pain. Clin J Pain 2015;31:265-72.  Back to cited text no. 31
Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain 1997;69:65-73.  Back to cited text no. 32
Taheri N, Rezasoltani A, Okhovatian F, Karami M, Hosseini SM, Kouhzad Mohammadi H. Quantification of dry needling on myofascial trigger points using a novel ultrasound method: A study protocol. J Bodyw Mov Ther 2016;20:471-6.  Back to cited text no. 33
Burckhardt CS, Jones KD. Adult measures of pain: The McGill pain questionnaire (MPQ), rheumatoid arthritis pain scale (RAPS), short-form mcgill pain questionnaire (SF-MPQ), verbal descriptive scale (VDS), visual analog scale (VAS), and West Haven-Yale multidisciplinary pain inventory (WHYMPI). Arthritis Care Res 2003;49:S96-104.  Back to cited text no. 34
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short-form mcgill pain questionnaire (sf-mpq), chronic pain grade scale (cpgs), short form-36 bodily pain scale (sf-36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res 2011;63:S240-52.  Back to cited text no. 35
Wallis JA, Taylor NF, Bunzli S, Shields N. Experience of living with knee osteoarthritis: A systematic review of qualitative studies. BMJ Open 2019;9:e030060.  Back to cited text no. 36
Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech (Bristol, Avon) 2009;24:833-41.  Back to cited text no. 37
Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. Trigger point acupuncture for treatment of knee osteoarthritis--a preliminary RCT for a pragmatic trial. Acupunct Med 2008;26:17-26.  Back to cited text no. 38
Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM, et al. Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43:620-34.  Back to cited text no. 39
Navarro-Santana MJ, Sanchez-Infante J, Fernández-de-Las-Peñas C, Cleland JA, Martín-Casas P, Plaza-Manzano G. Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: An updated systematic review and meta-analysis. J Clin Med 2020;9:E3300.