Efficacy Of Needling Myofascial Trigger Points In The Treatment Of Knee Osteoarthritis And Its Morphologic Changes

Objectives:Knee osteoarthritis is one of the most common degenerative diseases,which occurs in the elderly.The symptoms are not only knee pain and decreased function,but also appear in psychological,the quality of sleep and life,which seriously reduces the quality of life.Studies have shown that the occurrence of KOA may be related to the activation of Myofascial Trigger points.By inactivating Myofascial Trigger points,patients’ pain and range of motion can be improved,and the quality of life and sleep can be regulated.Therefore,the purpose of this study was to observe the effects of needling Myofascial Trigger points on clinical symptoms,psychology,the quality of sleep and life of patients with knee osteoarthritis.At the same time,ultrasound was used to observe the morphological changes of Myofascial Trigger points before and after treatment,so as to provide objective data on the location of Myofascial Trigger points and explore whether the morphological changes were related to the improvement of pain symptoms of patients.Methods:A total of 70 patients with KOA were enrolled in this study according to the sodium discharge criteria.The patients with KOA were divided into Experimental group(needling Myofascial Trigger points + muscle stretching)and Control group(sham needling Myofascial Trigger points + muscle stretching)using random number table method,with 35 patients in each group.In the Experimental group,0.30×75mm was used to intervene the Myofascial Trigger points of the quadriceps femoris,hamstring and gastrocnemius,and then the corresponding muscle stretching exercises were performed.The Control group was treated with a sham needling Myofascial Trigger points,where the needle was blunt and the skin was lightly touched,followed by the same stretching exercises as the Experimental group.Needling treatment once a week,lasted for 6 weeks as a course of treatment;Stretching exercises were performed twice a day in 2 groups of repetitions,each group was maintained for 30 seconds,and the intensity was subject to the patient’s mild and tolerable stretching.Before and after treatment,joint range of motion,pain score,psychology,the quality of sleep and life were measured in the Experimental group and the Control group,and morphological changes of Myofascial Trigger points were observed by ultrasound.Results:1.The NRS and KOOS scores of patients with KOA were significantly improved after acupuncture at the myofascial trigger point.Before treatment,there was no significant difference between the Experimental group and the Control group.6 weeks after treatment,the scores of NRS,ROM,and each dimension of KOOS of 2 groups was obviously improved,in 3 weeks after treatment,the Experimental group had an obvious effect,and the scores of NRS,KOOS are significant after 3 months of the treatment,the Control group had a rebound(p>0.05),the treatment effects of the Experimental group were significantly higher than the Control group.2.The HADS scores of patients with KOA were significantly improved after acupuncture at the Myofascial trigger point.There was no significant difference in HAS and HDS’s scores between the Experimental group and the Control group before treatment.After 6 weeks of treatment,all groups showed significant improvement.In 3 weeks after treatment,the Experimental group had an obvious effect,and the scores are significant after 3months of the treatment,the Control group had a rebound(p>0.05),the treatment effects of the Experimental group were significantly higher than the Control group.3.The PSQI、SF-36 scores of patients with KOA were significantly improved after acupuncture at the Myofascial trigger point.Before treatment,there was no significant difference in the scores of PSQI and SF-36 between the Experimental group and the Control group.After 6 weeks of treatment,indicators in each group showed significant improvement.In 3 weeks after treatment,the Experimental group had an obvious effect,and the scores of PSQI are significant after 3 months of the treatment,the Control group had a rebound(p>0.05),the treatment effects of the Experimental group were significantly higher than the Control group.4.The morphological characteristics of Myofascial trigger points were changed after acupuncture treatmentBefore treatment,hypoechoic signals of local thickening of the Myofascial Trigger points were observed under ultrasound.After 6 weeks of treatment,the thickness of Myofascial Trigger points decreased but did not disappear.The improvement of pain in KOA patients was correlated with the morphological changes of Myofascial Trigger points(R the proximal Myofascial Trigger point of medial femoris muscle =0.463,p < 0.05;R the distal Myofascial Trigger point of medial vastus =0.41,p < 0.05),and was positively correlated.Conclusions:1.Needling the Myofascial trigger points can improve the clinical symptoms,psychological status,the quality of sleep and life in patients with KOA,and without rebound 3 months after the end of treatment.2.Under ultrasound,the Myofascial Trigger points showed local thickened hypoechoic lesion signals.After the treatment of needing,the morphology of the Myofascial Trigger points changed but did not disappear.Moreover,the morphological changes of Myofascial Trigger points were correlated with the improvement of pain in patients with KOA.