Treatment of Subacute Posterior Knee Pain in an Adolescent Ballet Dancer Utilizing Trigger Point Dry Needling: a Case Report

Overview

Journal Int J Sports Phys Ther

Specialty Rehabilitation Medicine

Date 2014 Feb 26

PMID 24567862

Citations 7

Authors

John S Mason

Kimberly A Tansey

Richard B Westrick

Affiliations

Soon will be listed here.

Abstract

Study Design: Case Report.

Background And Purpose: Dry needling (DN) is an increasingly popular intervention used by clinicians as a treatment of regional neuromusculoskeletal pain. DN is an invasive procedure that involves insertion of a thin monofilament needle directly into a muscle trigger point (MTP) with the intent of stimulating a local twitch response. Current evidence is somewhat limited, but recent literature supports the use of this intervention in specific neuromusculoskeletal conditions. The purpose of this case report is to present the outcomes of DN as a primary treatment intervention in an adolescent subject with subacute posterior knee pain.

Case Description: The subject was a 16-year-old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient's primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles.

Outcomes: The subject reported being pain free on the Numerical Pain Scale and a +7 improvement in perceived change in recovery on the Global Rating of Change at final follow-up. Physical examination demonstrated no observed impairments or functional limitations, including normal mobility, full strength, and unrestricted execution of dance maneuvers.

Discussion: The patient was able to return to high level dance training and competition without physical limitations and resumed pre-injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long-term positive outcomes.

Level Of Evidence: Level 4.

Citing Articles

Dry Needling in Sports and Sport Recovery: A Systematic Review with an Evidence Gap Map.

Kuzdzal A, Trybulski R, Muracki J, Klich S, Clemente F, Kawczynski A Sports Med. 2025; .

PMID: 39928077 DOI: 10.1007/s40279-025-02175-9.

Comparative Study of the Efficacy of Hyaluronic Acid, Dry Needling and Combined Treatment in Patellar Osteoarthritis-Single-Blind Randomized Clinical Trial.

Velazquez Saornil J, Sanchez Mila Z, Campon Chekroun A, Baraja Vegas L, Vicente Mampel J, Frutos Llanes R Int J Environ Res Public Health. 2022; 19(17).

PMID: 36078628 PMC: 9517789. DOI: 10.3390/ijerph191710912.

Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review.

Skwiot M, Sliwinski Z, Zurawski A, Sliwinski G PLoS One. 2021; 16(6):e0253437.

PMID: 34166414 PMC: 8224967. DOI: 10.1371/journal.pone.0253437.

Acute Effects of Dry Needling on Myofascial Trigger Points in the Triceps Surae of Ballet Dancers: A Pilot Randomized Controlled Trial.

Janowski J, Phelan-Smith D, Kroat Brady M, Michels K, Timm A, Boucher N Int J Sports Phys Ther. 2021; 16(2):418-430.

PMID: 33842037 PMC: 8016472. DOI: 10.26603/001c.21475.

Validity of a Sham Dry Needling Technique on a Healthy Population.

Cushman D, Holman A, Skinner L, Cummings K, Haight P, Teramoto M Int J Sports Phys Ther. 2021; 16(1):49-56.

PMID: 33604134 PMC: 7872448.

References

Srbely J, Dickey J, Lee D, Lowerison M . Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010; 42(5):463-8. DOI: 10.2340/16501977-0535. View

English S, Perret D . Posterior knee pain. Curr Rev Musculoskelet Med. 2010; 3(1-4):3-10. PMC: 2941578. DOI: 10.1007/s12178-010-9057-4. View

von Baeyer C, Spagrud L, McCormick J, Choo E, Neville K, Connelly M . Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity. Pain. 2009; 143(3):223-227. DOI: 10.1016/j.pain.2009.03.002. View

Leanderson C, Leanderson J, Wykman A, Strender L, Johansson S, Sundquist K . Musculoskeletal injuries in young ballet dancers. Knee Surg Sports Traumatol Arthrosc. 2011; 19(9):1531-5. DOI: 10.1007/s00167-011-1445-9. View

Radford J, Burns J, Buchbinder R, Landorf K, Cook C . Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006; 40(10):870-5. PMC: 2465055. DOI: 10.1136/bjsm.2006.029348. View

Shah J, Danoff J, Desai M, Parikh S, Nakamura L, Phillips T . Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008; 89(1):16-23. DOI: 10.1016/j.apmr.2007.10.018. View

Kalichman L, Vulfsons S . Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010; 23(5):640-6. DOI: 10.3122/jabfm.2010.05.090296. View

Lucas C . Iliotibial band friction syndrome as exhibited in athletes. J Athl Train. 1992; 27(3):250-2. PMC: 1317254. View

Hong C . Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994; 73(4):256-63. DOI: 10.1097/00002060-199407000-00006. View

10.

Salaffi F, Stancati A, Silvestri C, Ciapetti A, Grassi W . Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004; 8(4):283-91. DOI: 10.1016/j.ejpain.2003.09.004. View

11.

Westrick R, Zylstra E, Issa T, Miller J, Gerber J . Evaluation and treatment of musculoskeletal chest wall pain in a military athlete. Int J Sports Phys Ther. 2012; 7(3):323-32. PMC: 3362990. View

12.

ESCAMILLA R . Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001; 33(1):127-41. DOI: 10.1097/00005768-200101000-00020. View

13.

Ohnmeiss D, Vanharanta H, Ekholm J . Relation between pain location and disc pathology: a study of pain drawings and CT/discography. Clin J Pain. 1999; 15(3):210-7. DOI: 10.1097/00002508-199909000-00008. View

14.

Bennett R . Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007; 21(3):427-45. DOI: 10.1016/j.berh.2007.02.014. View

15.

Stretanski M, Weber G . Medical and rehabilitation issues in classical ballet. Am J Phys Med Rehabil. 2002; 81(5):383-91. DOI: 10.1097/00002060-200205000-00013. View

16.

Williamson A, Hoggart B . Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005; 14(7):798-804. DOI: 10.1111/j.1365-2702.2005.01121.x. View

17.

Harvey D . Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med. 1998; 32(1):68-70. PMC: 1756061. DOI: 10.1136/bjsm.32.1.68. View

18.

Lin C, Su F, Lin C . Influence of ankle injury on muscle activation and postural control during ballet grand plié. J Appl Biomech. 2013; 30(1):37-49. DOI: 10.1123/jab.2012-0068. View

19.

Dembowski S, Westrick R, Zylstra E, Johnson M . Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Int J Sports Phys Ther. 2013; 8(3):328-39. PMC: 3679638. View

20.

Jaeschke R, Singer J, Guyatt G . Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989; 10(4):407-15. DOI: 10.1016/0197-2456(89)90005-6. View