The Effects of Dry Needling the Quadriceps or Gluteal Muscle Groups in the Multimodal Management of Patellofemoral Pain: A Critically Appraised Topic.

CLINICAL SCENARIO: Patellofemoral pain (PFP) places a large burden on patients and the larger health care system. Current best evidence suggests an impairment-driven approach to managing PFP. Deep-dry needling (DDN) is a potentially advantageous manual therapy for patients with PFP due to the proposed benefits, including improved blood flow and oxygen saturation, improved range of motion, and improved muscle extensibility and function. However, current best practices do not recommend the utilization of DDN in the management of PFP and fail to evaluate DDN as part of multimodal treatment, and only evaluate DDN of the quadriceps muscle group. This critically appraised topic evaluates the literature on inclusion of DDN as part of the multimodal treatment of PFP exploring multiple muscle groups impacting PFP.

CLINICAL QUESTION: In patients with PFP, does the inclusion of dry needling within a multimodal treatment program result in improved patient outcomes?

SUMMARY OF KEY FINDINGS: Fifteen articles were screened for inclusion criteria and 3 randomized controlled trials were accepted for inclusion. All 3 articles evaluated Dry Needling + Exercise versus Exercise. One of these articles evaluated Dry Needling of the quadriceps muscle group, and the other 2 evaluated Dry Needling of the posterolateral hip musculature. The studies that evaluated the posterolateral hip musculature found significant improvements in patient-reported outcomes over the control group. The study that evaluated the quadriceps muscle group found no added benefit of including Dry Needling with conventional exercise programs.

CLINICAL BOTTOM LINE: There is limited level 1b evidence to support the utilization of DDN within the multimodal management of PFP. Current literature supports DDN of posterolateral hip musculature over DDN of the quadriceps muscle group. Management of PFP should be guided by an impairment-driven approach.

STRENGTH OF RECOMMENDATION: SORT Grade of B based on limited level 1b evidence.