Type of Article:  Original Research

Volume 7; Issue 6 (December 2019)

Page No.: 3287-3294

DOI: https://dx.doi.org/10.16965/ijpr.2019.182


Zishta Patel, Ankit Srivastava, Ashok Shyam *, Parag Sancheti.

Sancheti Institute College Of  Physiotherapy, Sancheti Healthcare Academy, 11/12 Thube Park, Shivajinagar, Pune, Maharashtra, India.

Corresponding author: Dr. Ashok Shyam, Sancheti Institute College Of  Physiotherapy, Sancheti Healthcare Academy, 11/12 Thube Park, Shivajinagar, Pune– 411005, Maharashtra, India. E-Mail: doc.ashokshyam@gmail.com


Background: Patello-femoral pain syndrome is a very common complaint seen in adolescence and young adults characterized by pain around and behind the patella. There has been prevalence of trigger points in the quadriceps leading to disruption of the VMO/VL firing pattern due to muscle inhibition by pain. Current studies suggest the use of strengthening exercises for hip and knee not focusing on releasing the trigger points. Releasing these trigger points could give additional benefit to the patient and can also be employed along with other conventional therapies.

Purpose of the study: To find out which treatment method gives faster results and works directly on the pain and function of the patient.

Objectives: To assess the immediate effect of Dry Needling Vs Ultrasound on releasing Trigger points in Quadriceps in patients with Patello-femoral Pain Syndrome on pain and knee/lower extremity function.

Study Design:  Randomized Control trail

Setting: OPD setting.

Participants: 70 patients with chronic anterior knee pain, without any ligament, bony or sensory involvement around the knee.

Main outcome measures: Numerical Pain rating scale and Pressure Algometer.

Results: In the ultrasound group there was a change of 38.60% seen in NRPS post values with a mean difference of 2.21±1.21 and for pressure algometer a change of 36.23% was seen with a mean difference of 3.08±4.40. In the dry needling group there was a change of 64.53% seen in NRPS post values with a mean difference of 3.07±1.48 and for pressure algometer a change of 56.86% was seen with a mean difference of 8.36±6.90. When compared within group dry needling had a better effect than ultrasound on both NRPS and Pressure algomter.

Conclusion: The current study indicates that Dry needling is more effective than ultrasound for reducing pain and increasing functional outcome in patients with patellofemoral pain syndrome.

Key words: Anterior knee Pain, Patello-femoral Pain syndrome (PFPS), Trigger points, Dry Needling, Ultrasound.


  1. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A (2010) Gender differences in the incidence and prevalence of Patello-femoral pain syndrome. Scand J Med Sci Sports 20(5):725–730
  2. Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Berghe L Vanden, Cerulli G: Clinical classification of Patello-femoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc 2005, 13(2):122-130.
  3. Dixit S, Difiori JP, Burton M, Mines B. Management of Patello-femoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194-202.
  4. Heintjes EM, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Exercise therapy for Patello-femoral pain syndrome. Cochrane Database Syst Rev. 2003 Jan 1;4.
  5. Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports medicine and arthroscopy review. 2007 Jun 1;15(2):48-56.
  6. Gregory R Waryasz, Ann Y McDermott – Patello-femoral pain syndrome (PFPS) – a systematic review of anatomy and potential risk factors. Dynamic medicine, 2008 Dec; 7(1):9.
  7. Dippenaar DL. The association between myofascial trigger points of the quadriceps femoris muscle and the clinical presentation of Patello-femoral pain syndrome using a piloted Patello-femoral pain severity scale(Doctoral dissertation).
  8. Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupre GS, Besier TF. Patellar maltracking correlates with vastus medialis activation delay in Patello-femoral pain patients. The American journal of sports medicine. 2011 Mar;39(3):590-8.
  9. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiology clinics. 2007 Dec 1;25(4):841-51.
  10. Behrangrad S, Kamali F. Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for Patello-femoral pain syndrome in young adults: A double-blind randomized clinical trial. Journal of bodywork and movement therapies. 2017 Jul 1;21(3):554-64.
  11. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1. Upper Half of Body. Baltimore, Williams and Wilkins. 1999.
  12. Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. American journal of physical medicine & rehabilitation. 2001 Oct 1;80(10):729-35.
  13. Ga H, Choi JH, Park CH, Yoon HJ. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. The journal of alternative and complementary medicine. 2007 Aug 1;13(6):617-24.
  14. Srbely JZ, Dickey JP, Lowerison M, Edwards AM, Nolet PS, Wong LL. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain. 2008 Oct 15;139(2):260-6.
  15. Aguilera FJ, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. Journal of manipulative and physiological therapeutics. 2009 Sep 1;32(7):515-20.
  16. Kavadar G, Çağlar N, Özen Ş, Tütün Ş, Demircioğlu D. Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study. Agri. 2015 Oct 1;27(4):190-6.
  17. Angela Forster, Nigel Palastanga. Ultrasonic therapy. In: Angela Forster, Nigel Palastanga. Clayton’s Electrotherapy theory and practice. 9th New Delhi: A.I.T.B.S Publishers and distributers ; 2000:165-179.
  18. Val Robertson, Alex Ward, John Low, Ann Reed. Ultrasound. In: Val Robertson, Alex Ward, John Low, Ann Reed. Electrotherapy explained – principles and practice. 4th New Delhi: Elsevier; 2016:251-305.
  19. Dommerholt J, Mayoral del Moral O, Gröbli C. Trigger point dry needling. Journal of Manual & Manipulative Therapy. 2006 Oct 1;14(4):70E-87E.
  20. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. Journal of clinical nursing. 2005 Aug;14(7):798-804.
  21. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. The Journal of Strength & Conditioning Research. 2009 Jan 1;23(1):312-4.
  22. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015 Jul 1;49(14):923-34.
  23. Clijsen R, Fuchs J, Taeymans J. Effectiveness of exercise therapy in treatment of patients with patellofemoral pain syndrome: systematic review and meta-analysis. Physical therapy. 2014 Dec 1;94(12):1697-708.
  24. Kooiker L, Van De Port IG, Weir A, Moen MH. Effects of physical therapist–guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. journal of orthopaedic & sports physical therapy. 2014 Jun;44(6):391-B1.
  25. van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma‐Zeinstra SM, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews. 2015(1).
  26. Lack S, Barton C, Sohan O, Crossley K, Morrissey D. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. Br J Sports Med. 2015 Nov 1;49(21):1365-76.
  27. Espí-López GV, Serra-Añó P, Vicent-Ferrando J, Sánchez-Moreno-Giner M, Arias-Buría JL, Cleland J, Fernandez-De-Las-Penas C. Effectiveness of inclusion of dry needling in a multimodal therapy program for patellofemoral pain: a randomized parallel-group trial. journal of orthopaedic & sports physical therapy. 2017 Jun;47(6):392-401.
  28. Nyborg WL. Biological effects of ultrasound: development of safety guidelines. Part II: general review. Ultrasound in medicine & biology. 2001 Mar 1;27(3):301-33.
  29. Young SR, Dyson M. Macrophage responsiveness to therapeutic ultrasound. Ultrasound in medicine & biology. 1990 Jan 1;16(8):809-16.
  30. Enwemeka CS. The effects of therapeutic ultrasound on tendon healing. A biomechanical study. American journal of physical medicine & rehabilitation. 1989 Dec;68(6):283-7.
  31. Jackson BA, Schwane JA, Starcher BC. Effect of ultrasound therapy on the repair of Achilles tendon injuries in rats. Medicine and science in sports and exercise. 1991 Feb;23(2):171-6.
  32. Gan BS, Huys S, Sherebrin MH, Scilley CG. The effects of ultrasound treatment on flexor tendon healing in the chicken limb. Journal of Hand Surgery. 1995 Dec;20(6):809-14.
  33. Hains G, Hains F. Patello-femoral pain syndrome managed by ischemic compression to the trigger points located in the peri-patellar and retro-patellar areas: a randomized clinical trial. Clinical Chiropractic. 2010 Sep 1;13(3):201-9.

Cite this article: Zishta Patel, Ankit Srivastava, Ashok Shyam, Parag Sancheti. IMMEDIATE EFFECT OF DRY NEEDLING VS ULTRASOUND ON RELEASING TRIGGER POINTS IN QUADRICEPS IN PATIENTS WITH PATELLO-FEMORAL PAIN SYNDROME ON PAIN. Int J Physiother Res 2019;7(6):3287-3294. DOI: 10.16965/ijpr.2019.182