Short-term effectiveness of high-and low-intensity percutaneous electrolysis in patients with patellofemoral pain syndrome:A pilot study

BACKGROUND Unilateral patellofemoral pain syndrome(PFPS)is the most frequently diagnosed knee condition in populations aged<50 years old.Although the treatment of myofascial trigger points(MTrPs)is a common and effective tool for reducing pain,previous studies showed no additional benefits compared with placebo in populations with PFPS.Percutaneous electrolysis is a minimally invasive approach frequently used in musculotendinous pathologies which consists of the application of a galvanic current through dry needling(DN).AIM To evaluate changes in sensitivity,knee pain perception and perceived pain during the application of these three invasive techniques.METHODS A triple-blinded,pilot randomized controlled trial was conducted on fifteen patients with unilateral PFPS who were randomized to the high-intensity percutaneous electrolysis(HIPE)experimental group,low-intensity percutaneous electrolysis(LIPE)experimental group or DN active control group.All interventions were conducted in the most active MTrP,in the rectus femoris muscle.The HIPE group received a 660 mA galvanic current for 10 s,the LIPE group 220 mA×30 s and the DN group received no galvanic current.The MTrP and patellar tendon pain pressure thresholds(PPTs)and subjective anterior knee pain perception(SAKPP)were assessed before,after and 7 d after the single intervention.In addition,perceived pain during the intervention was also assessed.RESULTS Both groups were comparable at baseline as no significant differences were found for age,height,weight,body mass index,PPTs or SAKPP.No adverse events were reported during or after the interventions.A significant decrease in SAKPP(both HIPE and LIPE,P<0.01)and increased patellar tendon PPT(all,P<0.001)were found,with no differences between the groups(VAS:F=0.30;η2=0.05;P>0.05;tendon PPT immediate effects:F=0.15;η2=0.02;P>0.05 and tendon PPT 7-d effects:F=0.67;η2=0.10;P>0.05).A significant PPT increase in rectus femoris MTrP was found at follow-up in both the HIPE and LIPE groups(both,P<0.001)with no differences between the groups(immediate effects:F=1.55;η2=0.20;P>0.05 and 7-d effects:F=0.71;η2=0.10;P>0.05).Both HIPE and LIPE interventions were considered less painful compared with DN(F=8.52;η2=0.587;P<0.01).CONCLUSION HIPE and LIPE induce PPT changes in MTrPs and patellar tendon and improvements in SAKPP,and seem to produce less pain during the intervention compared with DN.

Exploring overweight and obesity beyond body mass index:A body composition analysis in people with and without patellofemoral pain

Background:We compared body mass index(BMI),body fat,and skeletal muscle mass between(1) a mixed-sex nonathletic cohort of people with patellofemoral pain(PFP) and pain-free people,and(2) a nonathletic cohort of people with PFP and pain-free people subgrouped by sex(i.e.,men and women with PFP vs.pain-free men and women).Methods:This cross-sectional study included 114 people with PFP(71 women,43 men) and 54 pain-free controls(32 women,22 men).All participants attended a single testing session to assess body composition measures,which included BMI,percentage of body fat(%BFBioimpedance),and skeletal muscle mass(both assessed by bioelectrical impedance analysis),and percentage of body fat(%BFskinfoid)(assessed by skinfold caliper analysis).A one-way univariate analysis of covariance(age and physical activity levels as covariates) was used to compare body composition measures between groups(i.e.,PFP vs.pain-free group;women with PFP vs.pain-free women;men with PFP vs.pain-free men).Results:Women with PFP presented significantly higher BMI,%BFBiompedance,and %BFSkinfold,and lower skeletal muscle mass compared to pain-free women(p≤0.04;effect size:-0.47 to 0.85).Men with PFP and men and women combined had no differences in BMI,%BFBioimpedance,%BFSkinfold,and skeletal muscle mass compared to their respective pain-free groups(p> 0.05).Conclusion:Our findings indicate that BMI and body composition measures should be considered as part of the evaluation and management of people with PFP,especially in women,who have demonstrated higher BMI and body fat and lower skeletal muscle mass compared to pain-free controls.Future studies should not assess body composition measures in a mixed-sex population without distinguishing men participants from women participants.

Overweight and obesity in young adults with patellofemoral pain:Impact on functional capacity and strength

Purpose:This study aimed to(a)investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain(PFP)and(b)explore the association of body mass index(BMI),body fat,and lean mass with functional capacity and hip and knee strength in people with PFP.Methods:We included a mixed-sex sample of young adults(18-35 years old)with PFP(n=100).Measurements for BMI,percentage of body fat,and lean mass(assessed by bioelectrical impedance)were obtained.Functional capacity was assessed by the Anterior Knee Pain Scale,plank test,and single-leg hop test.Strength of the knee extensors,knee flexors,and hip abductors was evaluated isometrically using an isokinetic dynamometer.The proportion of overweight/obesity was calculated based on BMI.The association between BMI,body fat,and lean mass and functional capacity and strength was investigated using partial correlations,followed by hierarchical regression analysis,adjusted for covariates(sex,bilateral pain,and current pain level).Results:A total of 38%of our cohort had their BMI categorized as overweight/obese.Higher BMI was associated with poor functional capacity(ΔR^(2)=0.06-0.12,p<0.001)and with knee flexion strength only(ΔR^(2)=0.04,p=0.030).Higher body fat was associated with poor functional capacity(ΔR^(2)=0.05-0.15,p≤0.015)and reduced strength(ΔR^(2)=0.15-0.23,p<0.001).Lower lean mass was associated with poor functional capacity(ΔR^(2)=0.04-0.13,p≤0.032)and reduced strength(ΔR^(2)=0.29-0.31,p<0.001).Conclusion:BMI,body fat,and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.

Case studies of Chinese acupuncture's comprehensive effectiveness on knee pain

Conventional Western medicine（CWM） and traditional Chinese medicine（TCM） have different approaches and lead to different practices in experimental design, research methodology, regulation, and standards. TCM emphasizes on the optimal or holistic health. In contrast, CWM is an allopathic medicine primarily based on anatomy, biology, biochemistry,molecular biology and modern technology, and rejects the concept of invisible substances and quantum entanglement.Consequently, CWM emphasizes on abnormal lab tests or obvious diseases. In the early 1970 s, TCM and acupuncture quickly emerged as an alternative to CWM as Westerners explored new TCM concepts while questioning the side effects of CWM. Many countries accept traditional acupuncture as a legal alternative medical practice. Some CWM physicians nowadays are more enthusiastic and are receptive to learning and practicing acupuncture. The common goal of CWM and TCM is to enhance human health, but problems arise over differences in approach. As a response to some Western journal papers that failed to validate the real acupuncture effect because of their incorrect methodologies and their ignorance of the holistic acupuncture approaches, the authors hereby present a group of case studies to demonstrate the real and unique effects of genuine acupuncture. The objective was to explore the clinical effects of acupuncture for knee pain.Thirty-six patients with knee pain were divided into five groups based on age. Holistic TCM diagnosis was performed at the beginning of each case and then made a personalized acupuncture treatment prescription according to the root of illness found by the diagnosis. The symptoms and signs were recorded before and after every treatment, and the treatment effects were assessed based upon the self-reported feeling and the observed changes of the patient following the numeric rating scale（NRS）. The results were summarized after the completion of the minimal 5 acupuncture treatments or the standard 10 acupuncture treatments. Among the 36 patients who participated in the cases studies, 17 patients reported a complete healing for knee pain（47.2%）. About 60 kinds of illness other than knee pain were improved（98.9%） and the complete healing rate was about 44.2%. This leads to the conclusion that TCM acupuncture is remarkably effective in treating knee pain. TCM and CWM share a common goal in promoting the health of human being. The efficacy of TCM acupuncture in treating knee pain shouldn＇t be denied or distorted.

Clinical Observation of Puncturing Lumbar Acupoints for Knee Joint Pain

Objective： To observe the clinical efficacy of puncturing lumbar acupoints in treating knee joint pain. Methods： Thirty-seven patients suffered from knee joint pain were treated by puncturing lumbar acupoints combined with cupping therapy. Visual Analog Scale （VAS） was scored before and after the first treatment as well as the second treatment. Result： Before treatment, VAS score was 5.3±1.2. After the first treatment, VAS score descended to 1.9±0.8. Before the second treatment, VAS score was 2.1±0.7. After the second treatment, VAS score descended to 0.7±0.6. Conclusion： Puncturing lumbar acupoints is quite effective in treating knee joint pain caused by lumbar diseases.

Electroacupuncture plus external application of Chinese medicine for knee osteoarthritis

Objective： To reveal the action mechanism and efficacy of electroacupuncture（EA） plus external application of Wei Ling Xian（Radix Clematidis） extract in treating knee osteoarthritis（KOA）, for providing theoretical evidence and novel plan for the treatment of KOA. Methods： Totally 284 inpatients were divided into an EA group and an observation group by the random number table, 142 cases in each group. The EA group was intervened by EA, ultrashort waves, and oral administration of Glucosamine Hydrochloride capsules; while the observation group was by external application of Wei Ling Xian（Radix Clematidis） extract at topical area in addition to the treatment given to the EA group. The intervention lasted 14 d in both groups. X-ray examination of knee joint was ordered before and after treatment, as well as the detection of positive expression of matrix metalloproteinase-1（MMP-1） in cartilage of knee joint, hyaluronic acid（HA） and interleukin-1β（IL-1β） in the inflammatory effusion; the Western Ontario and McM aster Universities osteoarthritis index（WOMAC） and visual analogue scale（VAS） were adopted to evaluate the clinical efficacy. Results： In the observation group, the X-ray examination result of knee joint was significantly improved, the positive expressions of MMP-1 and IL-1β content were significantly decreased, the level of HA was increased, WOMAC and VAS scores dropped, and the total effective rate was 91.5%, which were significantly different from those in the EA group（P〈0.05）. Conclusion： EA plus external application of Wei Ling Xian（Radix Clematidis） extract can produce a more significant efficacy in treating KOA compared to ordinary EA treatment.

Clinical research on the short-term efficacy of massaging quadriceps for knee osteoarthritis

Objective： To observe the short-term efficacy of massaging quadriceps on knee osteoarthritis （KOA）. Methods： Totally 30 KOA patients were enrolled and treated mainly with massaging quadriceps, 20 min for each session, once a day, 2 weeks as a treatment course, and for 2 courses in total. After treatment, the changes of visual analogue scale （VAS） and Western Ontario and McMaster Universities osteoarthritis index （WOMAC） were observed. Result： The VAS and WOMAC scores dropped after treatment, with a statistically significant difference （P〈0.01）. After a course of treatment, the recovery rate was 33.3% and the total effective rate was 86.7%; after 2 courses, the recovery rate was 60.0% and the total effect rate was 96.7%. Conclusion： Massaging quadriceps can alleviate pain, improve the function of knee joint, and produce a significant short-term efficacy in treating KOA.

Observation on clinical effects of herbal cake-partitioned moxibustion for knee osteoarthritis

Objective： To observe the clinical effects of herbal cake-partitioned moxibustion in the treatment of knee osteoarthritis （KOA）. Methods： A total of 120 cases with KOA were randomly divided into two groups by the random digital table, 60 cases in each group. The herbal cake-partitioned moxibustion （HCPM） group was treated by herbal cake-partitioned moxibustion, once per day and five days per week, with ten sessions as one course. The Western medication （WM） group was treated by the oral administration of Diclofenac Sodium Sustained-release Tablets. The knee functions of the patients were assessed by Western Ontario and McMaster Universities osteoarthritis index （WOMAC） before and after the treatment. The clinical effects were observed in the two groups after four-week continuous treatment. Results： The total effective rate was 86.7% in the HCPM group and 73.3% in the WM group. The difference in the total effective rate between the two groups was statistically significant （P〈0.05）. After treatment, WOMAC scores in the two groups were statistically different than those of the same group before the treatment （both P〈0.05）; the difference between the two groups were statistically significant （P〈0.05）. Conclusion： Herbal cake-partitioned moxibustion and oral administration of Didofenac Sodium Sustained-re;ease Tablets can improve the knee functions of KOA patients, but the therapeutic effect was better by herbal cake-partitioned moxibustion than by oral administration of Diclofenac Sodium Sustained-release Tablets.

Treatment of Infrapatellar Fat Pad Strain with Mountain-burning Fire Method

Strain of infrapatellar fat pad extensively occurs in people aged over 30 years, who often walk up hills or squat while working. The clinical manifestations are aching and weakness in the knee joints, aggravated when the knee joints are totally extended. Discomfort occurs in mild cases only when walking for long or going up and down the stairs. There is aching feeling in moderate cases when the patients are quiet. The pain is aggravated during exercises when the knee joints are half flexed and the patient can not stand up when squatting for prolonged periods of time. There are aching and weak feelings in the severe cases.