Discussion
knee muscle stretching, hip abductors, angulation, shoulder pain, KOA, MTrPs, pain, Patellofemoral Pain, tightness, muscle pain, knee flexion, knee varus angulation, patellofemoral, knee pain, weakness of hip external rotation
DEGENERATION, LOBO, BEND, CONTRACTION, CHRONIC PAIN
The current study investigated the effect of treatment with dry needling latent and active MTrPs combined with knee muscle stretching, and it compared that effect with the effect of treatment with oral diclofenac and knee muscle stretching. After treatments, both the groups showed a good effect in knee pain, function, and ROM, However, the DNG showed significantly better results than the DG. Especially in the results ofthe 6-month follow-up, the results of the DNGweresuperior tothose of the DG.Differentfrompreviousstudiesthat focused on dry needling active trigger points in the treatment of KOA, in this study, in addition to dry needling active trigger points, latent trigger points were also included, and there were several reasons why the latent trigger points dry needle were included. First, latent trigger points have a high prevalence in KOA. The research of Sánchez et al. [However, in recent years, latent trigger points have received attention and have been included in the treatment of various skeletal muscle pain. Calvo Lobo's research showed that dry needling intervention of the latent MTrPwasassociated with the key active MTrP of the infraspinatus reduces pain intensity in the short term in older adults with nonspecific shoulder pain [Currently, for the treatment of KOA, the active trigger point is primarily involved, and the active trigger point of quadriceps femoris is primarily included because the referred pain of the quadriceps femoris is near the patellofemoral joint. When activated, there is pain in the patellofemoral joint. Patellofemoral Pain Syndrome(PFPS), as the early lesion of OA, often achieves positive effects by needling the active trigger point of the quadriceps femoris [The effects of the included muscles on joint mechanics are as follows:(1). Quadriceps tightness can lead to an increased compression force of the patellofemoral joint [(2). The tensor the fascia lata is connected to the patellofemoral through the iliotibial band (ITB) and the sateral patellar retinaculum. The increased tension of the tensor fascia lata increases thepatellar lateral translation and tilt and increases thelateral cartilage pressure [(3). The hamstrings, apart frombeing the primary mechanism of knee flexion, also protect the knee from eccentric contraction during the support phase. These both function to cushion the joint and to generate limb deceleration during gait [(4). Inanopen-chain, the gastrocnemius muscle can bend the knee joint and ankle plantar flexion, and the soleus muscle can also bend the ankle plantar flexion. However, inaclosed-chain, the gastrocnemius muscle and soleus muscle pull the lower end of the femur and the lower leg backward to straighten the knee joint [(5). The gluteus medius is theprimary abductor of the hip. During walking, weak hip abductors of the stance limb produce a pelvic drop on the swing limb and stance knee varus angulation that shifts the line of gravity (LOG) away from the stance knee. This LOG shift increases the knee adduction moment and the medial joint compressive forces, leading to progressive degeneration. The hip adductor muscles may eccentrically counteract the varus angulation of the knee and consequently might unload the medial tibiofemoral joint [(6). Hip external rotation (the posterior fibers of the gluteus medius and maximus muscles) act eccentrically to control the movements of hip medial rotation during activities with body weight support.The weakness of hip external rotation leads to the internal rotation of the femur, and this contributes to increased lateral forces acting on the patella and greater stress on the lateral patellofemoral joint [Previous studies have reported that ROM of the knee joint is decreased gradually in individuals with KOA [Traditionally, clinicians have relied heavily on the use of NSAIDs, including diclofenac sodium to treat the symptoms of KOA, such as inflammatory pain and joint stiffness. Diclofenac is a proven, commonly prescribed nonsteroidal anti-inflammatory drug (NSAID) that has analgesic, anti-inflammatory, and antipyretic properties and has been shown to be effective in treating a variety of acute and chronic pain and inflammatory conditions.Despite its side effects, diclofenac sodium still remains the drug of choice [