Methods of treatments
twitch, numbness, MTrPs, pain, extensors, tightness
After the skin was locally sterilized, the MTrPs were transcutaneously punctured through the marks with a 0.30 mm × 40 mm or 0.30 mm × 75 mm sterilized disposable stainless-steel acupuncture needle. During dry needling, the left thumb or two fingers pressed or held the taut band. The right hand was used to quickly insert the needle into the entire layer of the skin to avoid skin tingling. The needle tip was then punctured back and forth into the taut band in different directions until a local twitch response was elicited. Once the first local twitch response was obtained, the needle was moved up and down (3–5-mm vertical motions with no rotations) at approximately 1 Hz until no more local twitch responses were elicited; if the patient's tolerance was poor, 1 or 2 local twitch responses were sufficient. The depth of needle insertion ranged from 15 to 65 mm and it depended on the depth of the muscles selected and the thickness of the fat. After pulling out the needle, ischemic compression with a finger was applied for 10 − 30 s. Dry needling treatment was administered once a week and dry needling treatments were terminated once VAS score was less than 3. For the trigger point marked by the surgical marker, if there is only a taut band but no hypersensitive spot, and no palpation with the reproduction of the patient’s symptoms at the next examination, the treatment of the trigger point will be terminated. In addition, the patients were taught to perform self-stretching exercises of knee flexors and extensors at home.Knee flexor self-stretching involved the standing hamstring stretch or the sitting toe touch stretch. For the standing hamstring stretch, participants stood with the involved leg elevated on a chair or stool. While standing tall, maintaining the neutral spine posture, and keeping the involved knee in full extension, subjects were instructed to lean forward hinging at the hips until moderate stretch discomfort was felt in the hamstrings [The stretching of the patient depended on the muscle with the trigger point, that is, when a certain muscle had a trigger point, the corresponding muscle stretch was performed.The above static stretching was maintained for 1 min and repeated three times per day. The extent of stretching is suitable for tightness, if there was discomfort such as numbness or pain, the patient needed to reduce the extent and time of stretching. Even after terminating the dry needling or oral medicine therapies, all patients would continually conduct it.