Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial

Patellofemoral pain syndrome (PFPS) is one of the most common knee conditions in active young adults, affecting up to 40% of the population. It is characterized by pain in the anterior or medial region of the knee, aggravated by activities that increase patellofemoral pressure, such as climbing stairs, squatting, and prolonged sitting. The vastus medialis obliquus (VMO) muscle is considered an important dynamic stabilizer of the patellofemoral joint, and its insufficiency may predispose to the development of PFPS. Myofascial trigger points in the VMO are commonly found in patients with PFPS and may contribute to symptoms.

This randomized clinical trial compared two manual treatment techniques for trigger points: dry needling (DN) and ischemic compression (IC). Fifty-four participants aged 20-30 years with a diagnosis of unilateral PFPS were randomized equally between the two groups. All participants had at least one active trigger point in the VMO of the symptomatic knee. The protocol included three treatment sessions over one week, with follow-up at 7 days, 1 month, and 3 months after treatment.

In the dry needling group, sterile acupuncture needles (0.25 mm diameter, 50 mm length) were inserted perpendicularly into the identified trigger points. The fast-insertion technique was used with vertical movements of 2-3 mm for 25-30 seconds to elicit local twitch responses. In the ischemic compression group, gradually increasing manual pressure was applied over the trigger point until the patient reported pain at level 7 on the numerical scale, maintaining that pressure for 90 seconds, repeating three times with 30-second intervals.

The main outcomes were assessed using the Kujala questionnaire (function), numerical pain scale (SRPN), and pressure pain threshold (PPT). Both groups demonstrated significant improvements in all measures throughout the follow-up period. Pain decreased from approximately 6.7 to 1.9 points on the 0-10 scale in both groups. Function improved from about 62 to 78 points on the Kujala questionnaire (0-100 scale).

The pressure pain threshold increased from 3.3 to 3.8 in both groups, indicating reduced sensitivity.

Importantly, no statistically significant differences were found between the two treatments at any follow-up time point. Both techniques showed similar and lasting effects, with benefits maintained up to 3 months after treatment. The effect size was considered large for both interventions, suggesting substantial clinical relevance.

The clinical implications suggest that both dry needling and ischemic compression are viable therapeutic options for patients with PFPS and trigger points in the VMO. The choice between techniques may depend on factors such as patient preference, therapist experience, and resource availability. Both approaches aim to normalize muscle function, reduce pain sensitivity, and improve VMO activation pattern, contributing to better patellar alignment.

The study has important limitations. Biomechanical factors such as the Q angle or degree of internal hip rotation, which could influence the results, were not assessed. In addition, the techniques were tested in isolation, without combination with exercises or other therapeutic modalities commonly used in clinical practice. Future studies should include control groups with sham treatment and investigate the VMO/vastus lateralis activation ratio to better understand the mechanisms of action.