Effectiveness of Dry Needling, Stretching, and Strengthening to Reduce Pain and Improve Function in Subjects with Chronic Lateral Hip and Thigh Pain: A Retrospective Case Series

This retrospective study investigated the effectiveness of dry needling combined with conventional physical therapy in the treatment of chronic lateral hip and thigh pain. The research included four patients with persistent pain for more than 90 days who had not responded adequately to previous treatments, including corticosteroid injections and traditional physical therapy. Dry needling is a technique in which monofilament needles are inserted into soft tissues to reduce pain and facilitate the return to normal function. In the protocol used, the researchers applied six needles per session: one in the central region of the greater trochanter of the femur and five along the lateral thigh, specifically in the iliotibial band or vastus lateralis muscle.

The needles were left in place for 15 minutes, and in three of the four patients, low-frequency electrical stimulation was applied. One patient did not receive electrical stimulation due to use of a cardiac pacemaker. Simultaneously, all participants performed conventional stretching and strengthening exercises. Treatment was administered once or twice a week, totaling between four and eight sessions over four to eight weeks.

Outcomes were evaluated using the Visual Analog Scale (VAS) for pain and the Lower Extremity Functional Scale (LEFS) for functional capacity, applied before treatment, immediately after its conclusion, and at long-term follow-up with a mean of 12.25 months. The results demonstrated clinically significant improvements in all participants. The mean LEFS score improved from 50.75 at baseline to 66.75 at the end of treatment, representing a gain of 16 points, well above the minimum clinically important difference of 9 points. At long-term follow-up, the mean was maintained at 65.50 points.

With respect to pain, the results were categorized as best, current, and worst pain levels. Best pain decreased from 20 mm to 0 mm on the 100-mm scale, current pain decreased from 25.75 mm to 11.75 mm, and worst pain dropped from 85 mm to 32.5 mm. All patients reported significant subjective improvement, including greater walking tolerance, reduction of intermittent limping, better sleep quality, and greater capacity for daily activities. These improvements were maintained at long-term follow-up.

The clinical implications suggest that dry needling may be a valuable addition to the therapeutic arsenal for lateral hip and thigh pain, especially in cases that do not respond to conventional treatments. The technique proved to be safe, with only minor adverse effects reported, such as transient muscle soreness. The standardized protocol used may facilitate replication of the technique in other clinical settings. However, it is important to recognize the significant limitations of this study.

As a case series with only four participants, it is not possible to establish definitive causal relationships or generalize the findings to larger populations. The absence of a control group prevents the determination of how much improvement was specifically due to dry needling versus conventional exercise. In addition, the retrospective design and lack of randomization limit the quality of the evidence. The heterogeneity in the application of electrical stimulation (three patients received it, one did not) also represents a confounding variable.

Despite these limitations, the results provide promising preliminary evidence that justifies larger randomized controlled trials to definitively establish the efficacy of dry needling in this specific clinical condition.