Shockwave Therapy Versus Dry Needling For The Management Of Iliotibial .
GMJ.2021;10:e2174www.gmj.irReceived 2021-04-02Revised 2021-05-19Accepted 2021-07-30Shockwave Therapy Versus Dry Needling for theManagement of Iliotibial Band Syndrome: A RandomizedClinical TrialRazie Maghroori1, Leila Karshenas1 , Saied Khosrawi11Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranAbstractBackground: Iliotibial band syndrome (ITBS) is a common leading cause of lateral knee pain.Despite varieties of medical and non-medical treatments proposed for the management of ITBS,the best therapeutic approach for its treatment remained a significant question. The currentstudy aims to compare the outcomes of dry needling (DN) versus shockwave therapy (SWT) inthe management of ITBS. Materials and Methods: This randomized clinical trial was conducted on 40 patients diagnosed with ITBS. The patients were randomly divided into two treatmentgroups of DN (n 20) and SWT (n 20). Visual analog scale for the pain assessment, LowerExtremity Functional Scale (LEFS) for the function evaluation, and length of the iliotibial bandwere assessed at baseline, immediately after the cessation of the intervention, and within fourweeks. Results: The two groups were similar regarding demographic characteristics (P 0.05).Both approaches could efficiently lead to improved pain (P 0.001) and promoted functionbased on LEFS (P 0.001); however, iliotibial band length (ITBL) did not alter remarkably(P 0.05). The groups were similar in terms of pain score, LEFS, and ITBL at all of the assessment intervals (P 0.05), but the pain score within four weeks following the interventions thatwere significantly better in DN (P 0.023). Conclusion: Based on our results, DN, as well asSWT, could remarkably lead to an improvement in pain and function among patients resentingfrom ITBS; however, none of the approaches was superior over the other. ords: Iliotibial Band Syndrome; Dry Needling; Extracorporeal Shockwave Therapy; PainIntroductionIIliotibial band syndrome (ITBS) is aleading cause of pain complaints in thelateral aspect of the knee and is mostlynotified in runners [1]. ITBS is an overusesyndrome probably occurring because offriction between the iliotibial band (ITB)and the lateral epicondyle of the knee, whilethe knee is about 30 degrees flexed.This continual process poses an inflammationin the distal part of the ITB, leading to notifying severe disabling pain in the knee, lateral thigh, and hip and prevents a person fromparticipating in physical activities [2, 3].Length of the leg and increase in the lateral femoral epicondyle prominence are thenon-modifiable factors associated with ITBSand the modifiable factors such as muscleweakness in the hip abductor muscles,GMJ Copyright 2021, Galen Medical Journal. This isan open-access article distributed under the terms ofthe Creative Commons Attribution 4.0 InternationalLicense :info@gmj.irMedical Sciences, Isfahan, IranCorrespondence to:Leila Karshenas, Department of Physical Medicine andRehabilitation, School of Medicine, Isfahan University ofTelephone Number: 989132329025Email Address: krs.leila@gmail.com
Maghroori R , et al.particularly reduced flexibility of the hip,and abnormal kinematics of the lower extremity [1]. Despite varieties of theories proposedfor the underlying etiology of ITBS, the therapeutic approach for its treatment remaineda major question. The patients with mildsymptoms are primarily treated medicallyusing non-steroidal anti-inflammatory drugs(NSAIDs); however, numerous biopsiesopposed the presence of inflammation[1]. Physical therapies, static stretching,strengthening, manual therapy, deep frictionmassage, and appropriate shoe worn, plustraining schedules, are the other recommended options for ITBS treatment. In cases withlong-term irresponsive ITBS, surgery hasbeen used as the last alternative [3-5].Nevertheless, the surgical procedure isinvasive, and the outcomes of the otherapproaches were controversial [1]. Dryneedling (DN), as well as shockwave therapy (SWT), has been successfully usedfor various musculoskeletal disorders suchas myofascial pain, enthesitis, tendonitis,fasciitis, and trigger point [6-9].However, the information about the efficacyof DN for ITBS is limited to some casereports and only a cease series [10-12], anda few studies have assessed SWT [13].Therefore, the current study was designedto investigate the efficacy of DN versusSWT in ITBS management.Materials and Methods1. Study PopulationThis randomized controlled clinical trial wasconducted on 40 patients diagnosed with ITBSand referred to the Physical medicine andRehabilitation outpatient clinics affiliated withIsfahan University of Medical Sciences fromMay 2018 to August 2019. The study protocolwas approved by the Ethical Committee ofIsfahan University of Medical Sciences (codenumber: IR.MUI.MED.REC.1398.161).Besides, this report as a phase 3 trial wasproposed for the Iranian Registry of Clinical Trials and legislated based on the codeIRCT20190824044598N1. The protocolwas explained to the patients, they werereassured about the confidentiality of theirpersonal information, and written consent2SWT Vs. DN for the Treatment of ITBSwas obtained. Patients (ranged 18-60 yearsold) with documented ITBS diagnoses whohad normal neurological examinations wereincluded. ITBS was diagnosed by an expertphysical medicine and rehabilitation specialistaccording to the clinical physical examination,positive Ober's test, and the presence of theleast one trigger point on an ITB.Any fracture in thigh, knee, or shin or anysurgical procedure on the affected knee withinthe last 12 months, application of any therapeutic intervention to control the chronic kneepain (i.e., physiotherapy and/or injections attrigger points) within two months, and theuse of NSAIDs for over two weeks before theinterventions, radiculopathies, coagulopathy,and anticoagulant agents use were consideredthe unmet criteria. Reluctance to participatein the study, over 20% defects in the medicalrecords, and failure to participate in reassessments were the exclusion criteria of thecurrent study.Convenience sampling was administered toinclude the studied population. After that, theparticipants were randomly allocated to DNtherapy and SWT using Random AllocationSoftware (Excel software, Microsoft Office2010, The United States). Therefore, thepatients with odd numbers were allocatedto DN therapy and those with even numbersto the shockwave therapy. The person whogathered the data about the outcomes of theinterventions was blinded to the type of treatment.2. InterventionsThe trigger points were primarily found basedon pincer palpation on the lateral aspect of thethigh and lateral femoral epicondyle. To keepthe location of the trigger points between thesessions of interventions, a 10*10 cm centrallyperforated piece of a paper was administered[14].2.1. DN TherapyThe patients allocated to the DN group underwent the intervention twice a week for fourweeks. A skilled target physical medicineand rehabilitation specialist performed thistechnique in a sterile condition to minimizethe potential bias. The patient was asked tosleep on the opposite side of the affected leg;GMJ.2021;10:e2174www.gmj.ir
SWT Vs. DN for the Treatment of ITBSthe painful leg was upward and put a pillowbetween the legs. The interventionist cleanedthe penetration site with isopropyl alcohol70%, then wore sterile gloves and performedthe needling. In this term, the trigger pointfirmly held between the thumb and the pointing finger by non-dominant hand and a 0.25mm, 25-gauge needle by the dominant hand.Therefore, the needle was rapidly insertedinto the trigger point via a 30 angle andtaken out at low speed. Following the insertion of the needle, a local twitch response mayoccur. Therefore, the fanning technique wasapplied in which the needle was repeatedlyinserted into diverse parts of the trigger pointand pulled out as long as there was no furthertwitch. Eventually, the needle was preservedfor 15 minutes to achieve the analgesic effects[15, 16].2.2. SWTThe latter group of the patients underwentSWT once a week for four weeks. The patients slept laterally with 30 angle betweenthe thighs and shins. No local anesthesia wasadministered.The SWT was done by electromagnetic typeDornier AR2 machine (Storz Medical, Tagerwilen, Switzerland) radial probe. SWT wasinitiated using 500 pulses at 0.10 mJ/mm2(2Bar) with 15 Hz frequency to the lateralfemoral condyle to adjust to the treatment.An additional 2000 pulses were applied at0.10mJ/mm2–0.4 mJ/mm2 (2–4 Bar), 15Hz, depending on pain tolerance. Eventually,three lateral thigh trigger points were treated[13]. All of the patients (regardless of the intervention) were trained to perform a similarstretching ITB exercise. The performance ofexercises was recalled and checked throughtelephoning by the study's correspondentstwice a week. In cases with pain compliant,only every 6-hour oral acetaminophen 500 mgwas allowed.3. Means of AssessmentAll of the patients were followed for fourpost-intervention weeks, and the evaluationswere performed at baseline, immediately bythe last session of interventions, and withinfour weeks after the intervention cessation. Inorder to minimize the probable bias, all the as-GMJ.2021;10:e2174www.gmj.irMaghroori R , et al.sessments were performed by a skilled physical medicine and rehabilitation specialist. Thedemographic characteristics, including ageand gender, were recorded in the study checklist. A visual analog scale (VAS) was appliedto assess pain severity. Lower Extremity Functional Scale (LEFS) and iliotibial band length(ITBL) then further evaluated parameters.3.1. VASThe VAS score is a self-reported scale toassess the pain severity ranging from 0 to 10,representing the least to the most severe painsensation [17].3.2. LEFSLEFS is a questionnaire containing 20 itemsassessing the lower extremity function basedon the intensity of the related activities'performance. This scoring system is designedbased on the five-score Likert scale rangingfrom zero as the worst condition to four aswithout bothersome. This scale scores fromzero to eighty, and the higher score representa better condition. Negahban et al. have validated the Persian version of LEFT with Cronbach's alpha of above 0.70 for each item [18].3.3. The length of the iliotibial bandOber test was administered to assess thenormality of ITBL as well as its measurement.The patient was asked to sleep on the oppositeside of the affected leg; therefore, the painfulleg was upward. The lower leg was flexed inhip and knee joints. The examiner put one ofthe hands on the hip joint and the other underthe examined knee. Then, the affected kneewas 90 flexed without any rotation in the hipjoint, where the hip joint was extended simultaneously. At this moment, the examiner takesthe hand, which holds the knee away. If theITBL was normal, the gravity pulls the kneedown at a level under the bed, and the test wasinterpreted as negative; while in the shortenedbands, the thigh was stopped at levels higherthan the bed. The distance between the bed tothe medial aspect of the patella was measuredusing a calibrator ruler [19].4. Statistical AnalysisThe obtained data were entered into theStatistical Package for Social Sciences (SPSS,3
Maghroori R , et al.version 25, IBM Corporation, Armonk, NY,USA). Continuous data were presented inmean and standard deviation (SD). Absolutenumbers and percentages were administeredto present qualitative information. Fisher'sexact test, Mann-Whitney test, t-test, repeatedmeasure ANOVA, and generalized estimatingequation (GEE) test were utilized for analytics. A P 0.05 was determined as the level ofsignificance.ResultsIn the current study, the eligibility of 48 caseswith the diagnosis of ITBS has been evaluated;among them 40 patients met the criteria forparticipation in the study and were randomlyallocated to the DN therapy (n 20) and SWT(n 20, Figure-1).The mean age, body mass index (BMI), andthe duration of ITBS of the studied population was 51.83 14.64 (range:22-78 years),25.98 3.64 (range:19.10-34.55 kg/m2), and28.4 17.25 (0.5-120 months), respectively.The comparison of the two groups regardingthe demographic data revealed no significantdifferences (P 0.05, Table-1).The baseline pain assessment showed nosignificant difference between the two groups(P 0.38) as well as the comparison immediately following the intervention cessation(P 0.39); however, the pain score was remarkably less in the DN-treated group (P 0.023).Both of the interventions led to a significantimprovement of pain by the time in eachSWT Vs. DN for the Treatment of ITBSgroup (P 0.001).Besides, in contrast to lacking any difference between the two groups at the intervalassessments of LEFS in any of the evaluations(P 0.05), repeated measure ANOVA showeda significant change in the LEFS scores ofboth the treatment approaches (P 0.001,Table-2).None of the interventions showed a statisticallyremarkable alteration in the ITBL (P 0.05).In addition, the comparison of ITBL at baseline between the groups showed no difference(P 0.56) as well as the assessments at the timeof intervention cessation (P 0.86) and withinfour weeks post-intervention (P 0.79). Noneof the administered approaches was accompanied by any significant complication.DiscussionThe current study was conducted to comparethe efficacy of SWT versus DN to managecases with ITBS. The two assessed groupswere similar in terms of demographic characteristics; therefore, the possible confoundingrole of these factors is eliminated, and theresults are dedicatedly contributed to the treatment approach. Both treatments could properlyimprove the pain and LEFS, but not ITBL.The comparison of DN versus SWT generallyrevealed that the approaches were non-inferiorover the other; however, those under the DNapproach experienced significantly less severepain in the four-week follow-up investigation.Limited studies in the literature have com-Table 1. The Comparison of the Demographic Information Between the Studied Groups.VariablesDry Needling(n 20)Gender, n (%)FemaleMaleAge, mean SDBody mass index, mean SDDuration of the ITBS, mean SD15 (75)5 (25)49.1 12.3126.68 3.4722 34.58GroupsShockwave(n 20)15 (75)5 (25)54.55 16.5225.25 3.7611.7 19.88P-value 0.999*0.24**0.22**0.11 * Fisher's Exact Test; ** T-test; Mann-Whitney4GMJ.2021;10:e2174www.gmj.ir
SWT Vs. DN for the Treatment of ITBSMaghroori R , et al.Table 2. The Comparison of Pain Severity, LEFS, and ITBL Between the Studied Groups.VariablesDry NeedlingShockwave(n 20)(n 20)Means SDP-valuePainBaselineImmediately by the Intervention CessationWithin Four Weeks After the InterventionP-value**Lower Extremity FunctionBaselineImmediately by the Intervention CessationWithin Four Weeks After the InterventionP-value 8.95 1.143.05 2.081.75 1.77 0.0018.3 1.833.8 2.393.6 2.68 0.0010.38*0.39*0.023*34.9 16.655.15 17.8654.9 17.77 0.00138.65 12.5247.9 14.0349.7 14.14 0.0010.42δ0.16δ0.31δLength of ITBBaselineImmediately by the Intervention CessationWithin Four Weeks After the InterventionP-value**26.35 5.6725.7 6.1325.9 6.010.9324.4 6.7825.2 5.9525.75 4.710.750.560.860.79* Mann-Whitney; ** GEE; δ Independent t-test; Repeated Measure ANOVApared DN versus SWT. Walsh et al. [8] compared the efficacy of SWT versus DN ontrigger points in the quadriceps muscle. Theyperformed the interventions only for a weekand did not follow their patients. Like thecurrent study, they presented significant painimprovement following both the approaches,but none of them was superior to the other [8].Rahbar et al. [6] compared the outcomes ofDN versus SWT on the pain and function ofthose resenting from plantar fasciitis in a studyon 72 patients. Patients under both treatmentsdeveloped significant rehabilitation regarding pain and function. The follow-up investigations revealed DN's superiority to SWTwithin eight weeks after the intervention [6].Further studies assessing DN only have beenaccompanied by favorable outcomes. Rayeganiet al. [7] tried to evaluate the efficacy of DNfor the management of trigger points in thetrapezius muscle. Their study achieved promising outcomes in terms of pain relief at rest,at night, and during activity and improvementin the quality of life [7]. Similar results werefound in another study with a similar designassessing DN utility on ITBS. The efficacy ofDN was to the extent that the patient couldGMJ.2021;10:e2174www.gmj.irlie on the involved side and walk for a moreextended period [11]. Another case seriesrevealed outcomes in favor of DN regardingboth pain relief and improved function in theshort-term as well as the long-term assessment of the patients [12]. Castro-Sánchez etal. made a thorough investigation of DN usedfor trigger points in latissimus dorsi muscle,multifidus muscle, and quadratus lumborumand reported significant pain relief of allassessed areas [20].The action mechanism of DN is unknown;however, the mechanical destruction of thedysfunctional endplates responsible for asustained contraction of muscle fiber due tothe continuous release of acetylcholine seemsto play the primary role in DN. Therefore, bythe destruction of nerve end plates, the musclefibers contraction terminates, and eventually,the nociceptive impulses to the centralnervous system would cease [21, 22].Moghtaderi et al. used SWT for the triggerpoints in gastrocnemius/soleus muscles. Theirinvestigation was accompanied by considerable improvements in the evaluated patients'pain complaints and muscular function [23].The outcomes were confirmed in another5
Maghroori R , et al.SWT Vs. DN for the Treatment of ITBSFigure 1. Consort diagram of the studied population.study on cases suffering from trigger pointson the quadratus lumborum muscle [24].SWT has been successfully administered fornumerous overuse injuries such as patellartendinopathies, palmar fasciitis, and shouldercalcific tendonitis [25, 26]. SWT's mechanismleading to the promotion of the function andpain relief at the site of these types of chronicinjuries is debatable. Increase in the microcirculation Improvement in the local microcirculation, developing the metabolic activities,and washing the inflammatory agents responsible for pain out from the site of injury areone of the most favored theories about themechanism of SWT [27-29]. This theory wasreinforced by the interpretation of the biopsiestaken from the site of a trigger point on thelateral femoral epicondyle [30].The hyperstimulation analgesic effect isanother mechanism proposed for SWT and6is supported due to the intervention's immediate pain relief [31]. We assume that SWTmay have an anti-fibrotic effect on the injuredsoft tissue [32]. This theory is reinforced bythe other studies assessing SWT use on theoveruse of soft tissue injuries such as adhesivecapsulitis or rotator cuff injury [33].The short-term follow-up of the patients wasthe most prominent limitation of the currentstudy. We have not assessed the post-intervention strength of the muscles, which is stronglyrecommended for further investigations.ConclusionBased on this study, DN and SWT couldremarkably improve pain and function amongpatients resenting from ITBS; however, ouroutcomes revealed non-inferiority of eachapproach over the other. To generalize theGMJ.2021;10:e2174www.gmj.ir
SWT Vs. DN for the Treatment of ITBSoutcomes, further studies with a more extendedfollow-up period are recommended.AcknowledgmentThe authors of this manuscript want toacknowledge Dr. Ali Safaei for his efforts inMaghroori R , et al.conducting and preparing the current study.Conflict of InterestThe authors of the current study declare noconflict of interest.References1. Aderem J, Louw QA. Biomechanicalrisk factors associated with iliotibialband syndrome in runners: a systematicreview. BMC Musculoskelet Disord.2015;16(1):1-16.2. Pegrum J, Self A, Hall N. Iliotibial bandsyndrome. BMJ. 2019;364(1):l980-86.3. Baker RL, Fredericson M. Iliotibial bandsyndrome in runners: biomechanicalimplications and exercise interventions.Phys Med Rehabil Clin N Am.2016;27(1):53-77.4. Lavine R. Iliotibial band frictionsyndrome. Curr Rev Musculoskelet Med.2010;3(14):18-22.5. Walbron P, Jacquot A, Geoffroy J-M,Sirveaux F, Molé D. Iliotibial bandfriction syndrome: An original techniqueof digastric release of the iliotibial bandfrom Gerdy's tubercle. Orthop TraumatolSurg Res. 2018;104(8):1209-13.6. Beals C, Flanigan D. A Review ofTreatments for Iliotibial Band Syndromein the Athletic Population. J Sports Med(Hindawi Publ Corp). 2013;1(1):1-6.7. Rahbar M, Eslamian F, ToopchizadehV, Jahanjoo F, Kargar A, Dolatkhah N.A Comparison of the Efficacy of DryNeedling and Extracorporeal ShockwaveTherapy for Plantar Fasciitis: ARandomized Clinical Trial. Iranian RedCrescent Medical Journal. 2018;20(9):110.8. Rayegani SM, Bayat M, Bahrami MH,Raeissadat SA, Kargozar E. Comparisonof dry needling and physiotherapy intreatment of myofascial pain syndrome.Clin Rheumatol. 2014;33(6):859-64.9. Walsh R, Kinsella S, McEvoy J. The effectsof dry needling and radial extracorporealshockwave therapy on latent triggerGMJ.2021;10:e2174www.gmj.irpoint sensitivity in the quadriceps: Arandomised control pilot study. J BodywMov Ther. 2019;23(1):82-8.10. Walsh R. The effects of dry needling andradial extracorporeal shockwave therapyon the sensitivity of trigger points inthe quadriceps and jump performance:A randomised control trial. Institute ofTechnology Carlow; 2017.11. Shamus J, Shamus E. The managementof Iliotibial band syndrome with amultifaceted approach: A doublecase report. Int J Sports Phys Ther.2015;10(3):378-90.12. Pavkovich R. The use of dry needling fora subject with chronic lateral hip and thighpain: a case report. Int J Sports Phys Ther.2015;10(2):246-55.13. Pavkovich R. Effectiveness of dryneedling, stretching, and strengtheningto reduce pain and improve functionin subjects with chronic lateral hip andthigh pain: A retrospective case series.International journal of sports physicaltherapy. 2015;10(4):540-51.14. Weckström K, Söderström J. Radialextracorporealshockwavetherapycompared with manual therapy in runnerswith iliotibial band syndrome J BackMusculoskelet Rehabil. 2016;29(1):16170.15. Tabatabaei A EE, Ahmadi A, SarrafzadehJ. Comparison between the effect ofpressure release and dry needling on thetreatment of latent trigger point of uppertrapezius muscle. PTJ. 2013;3(3):9-15[Persian].16. Hong C-Z. Lidocaine injection versus dryneedling to myofascial trigger point. Theimportance of the local twitch response.Am J Phys Med Rehabil. 1994;73(4):256-7
Maghroori R , et al.63.17. Simons DG, Travell J, Simons LS.Myofascial pain and dysfunction: thetrigger point manual: volume 1. 1999.18. Kim J, Lee KS, Kong SW, Kim T, KimMJ, Park S-B, et al. Correlations betweenelectrically quantified pain degree,subjectively assessed visual analoguescale, and the McGill pain questionnaire:a pilot study. Ann Rehabil Med.2014;38(5):665-72.19. Negahban H, Hessam M, TabatabaeiS, Salehi R, Sohani SM, Mehravar M.Reliability and validity of the Persianlower extremity functional scale (LEFS)in a heterogeneous sample of outpatientswith lower limb musculoskeletaldisorders. Disabil Rehabil. 2014;36(1):16.20. Mozey, A, Gholamhossienpour O, Nejati,P. The correlation of patellar position andiliotibial band length with body massindex in patients with anterior knee pain.JSKUMS. 2018;20(4):63-75.21. Castro-Sánchez AM, Garcia-Lopez H,Mataran-Penarrocha GA, FernándezSánchez M, Fernández-Sola C, GraneroMolina J, et al. Effects of dry needlingon spinal mobility and trigger points inpatients with fibromyalgia syndrome.Pain Physician. 2017;20(2):37-52.22. Unverzagt C, Berglund K, Thomas J. Dryneedling for myofascial trigger point pain:a clinical commentary. Int J Sports PhysTher. 2015;10(3):402-18.23. Zhu H, Most H. Dry needling is one typeof acupuncture. Medical Acupuncture.2016;28(4):184-93.24. Moghtaderi A, Khosrawi S, Dehghan F.Extracorporeal shock wave therapy ofgastroc-soleus trigger points in patientswith plantar fasciitis: A randomized,placebo-controlled trial. Adv BiomedRes. 2014;3(99):1-4.25. Hong JO, Park JS, Jeon DG, Yoon WH,8SWT Vs. DN for the Treatment of ITBSPark JH. Extracorporeal shock wavetherapy versus trigger point injection inthe treatment of myofascial pain syndromein the quadratus lumborum. Ann RehabilMed. 2017;41(4):582-8.26. Moya D, Ramón S, Schaden W, WangC-J, Guiloff L, Cheng J-H. The role ofextracorporeal shockwave treatmentin musculoskeletal disorders. JBJS.2018;100(3):251-63.27. Wang C-J. Extracorporeal shockwavetherapy in musculoskeletal disorders. JOrthop Surg Res. 2012;7(1):11-8.28. Gleitz M. Myofascial Syndromes andTriggerpoints: Level10 Buchverlag; 2019.29. Galasso O, Amelio E, Riccelli DA,Gasparini G. Short-term outcomes ofextracorporeal shock wave therapy forthe treatment of chronic non-calcifictendinopathy of the supraspinatus: adouble-blind, randomized, placebocontrolled trial. BMC musculoskeletdisord. 2012;13(1):86-95.30. Zamzam M, El Yasaki A, ElGarabawy N,El Ghandour LEE. Shockwave therapyversus local steroid injection in chronicsupraspinatustendinopathy.EgyptRheumatol Rehabil. 2019;46(3):141-7.31. Del Castillo F, Ramos Álvarez JJ, RodriguezFabián G, González Pérez J, JiménezHerranz E, Varela E. Extracorporealshockwaves versus ultrasound-guidedpercutaneous lavage for the treatmentof rotator cuff calcific tendinopathy: arandomised controlled trial. Eur J PhysRehabil Med. 2016;52(2):145-51.32. Knobloch K, Kuehn M, Vogt PM. Focusedextracorporeal shockwave therapy inDupuytren’s disease–a hypothesis. MedHypotheses. 2011;76(5):635-37.33. Maffulli N, Maffulli G. The assessment ofthe effectiveness of extracorporeal shockwave therapy (ESWT) for soft tissueinjuries (ASSERT): two year results.MLTJ. 2018;8(3):46-51.GMJ.2021;10:e2174www.gmj.ir
fasciitis, and trigger point [6-9]. However, the information about the efficacy of DN for ITBS is limited to some case reports and only a cease series [10-12], and a few studies have assessed SWT [13]. Therefore, the current study was designed to investigate the efficacy of DN versus SWT in ITBS management. Materials and Methods 1. Study Population
Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Med Rehabil. 2007 May;86(5):397-403. 5. Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports
37 This randomized clinical trial investigated the effectiveness of exercise vs. exercise 38 plus trigger point dry needling (TrP-DN) in subacromial pain syndrome. A randomized . 101 for the management of active TrPs, with manual therapies, trigger point injections, and dry 102 needling (TrP-DN) being among the most commonly used.
Randomized clinical trial comparing the use of dry needling to mobilizations . rather than myofascial trigger point (MTrP) -MTrP lack a uniform definition {Quintner,2014} -Palpation lacks reliability . Time Point Dry Needling Mobilization. 10/10/2017 7 PSFS Score 0. 2.5 5. 7.5 10.
Needling” Use by Arizona Licensed Physical Therapists . Charles D. Brown . I.Summary . The enclosed documents have been submitted to the Arizona Board of Physical Therapy in relation to the use of treatment called “Dry Needling” by physical therapists in Arizona and the Board’s ong
Purpose: To investigate the effects of trigger point dry needling (TrP-DN) on exercise-induced patellofemoral pain syndrome (PFPS). Patients and Methods: In this randomized, single-blind, parallel-group trial, 50 patients with PFPS were randomly allocated to the following two groups: the TrP-DN group (n 25) and the Sham needling group (n 25).
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All Star Legacy Divas Junior Prep Level 2 17 73.3 3 3 3 Shockwave Allstars Intensity Junior Prep Level 2 21 71.9 4 NA NA Galaxy Allstars SuperNova Junior Prep Level 2 11 68.4 5 NA NA Shockwave Allstars Vortex Senior Prep Level 2 30 72.8 1 1 1 FAME Victorious Senior Prep Level 2 21 72.5 2 2 2 Shockwave Allstars Flare Junior Prep Level 3 22 72.35 .
Austin, Oscar Palmer Nacogdoches, TX Vietnam War Austin, William . Lopez, Jose Mendoze Mission, TX (Santiago Huitlan, Mexico) World War II (Most sources say that Lopez was born in Texas but he later stated in multiple interviews and his funeral program recorded that he was born in Mexico) Lummus, Jack Ennis, TX World War II Martinez, Benito Fort Hancock, TX Korean War . Compiled by Gayle .
