Background and Purpose:
Chronic lateral hip and thigh pain is regularly treated by the physical ... more Background and Purpose: Chronic lateral hip and thigh pain is regularly treated by the physical therapist. Many issues can cause pain in this region, and trigger points may contribute to pain. Dry Needling (DN) is an intervention used by physical therapists where a monofilament needle is inserted into soft tissue to reduce pain thereby facilitating return to prior level of function. The purpose of this case series is to report the outcomes of DN and conventional physical therapy as a treatment intervention for subjects with chronic lateral hip and thigh pain.
Case Descriptions: Four subjects with chronic lateral hip and thigh pain attended between four and eight sixty-minute sessions of dry needling and stretching/ strengthening activities over a four to eight week intervention course. Outcomes were tested at baseline and upon completion of therapy. A long-term follow up averaging 12.25 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Lower Extremity Functional Scale (LEFS).
Outcomes: The LEFS and VAS indicated clinically meaningful improvements in disability and pain in the short term and upon long term follow up for each subject. The LEFSmean for the four subjects improved from 50.75 at baseline to 66.75 at the completion of treatment. At long-term follow-up, the LEFSmean was 65.50. Each subject met the minimal clinically important difference (MCID) and minimal detectable change (MDC) for the LEFS and the VAS. The VAS was broken down into best (VASB), current (VASC), and worst (VASW) rated pain levels and averaged between the four subjects. The VASB improved from 20 mm at the initial assessment to 0 mm upon completion of the intervention duration. The VASC improved from 25.75 mm to 11.75 mm, and the VASW improved from 85 mm to 32.5 mm. At the long-term follow up (average 12.25 months), the VASB, VASC, and VASW scores were 0 mm, 14.58 mm, and 43.75 mm respectively.
Discussion: Clinically meaningful improvements in pain and disability were noted. Subjects reported improved sleep and functional mobility, which were commensurate with their different age ranges and initial reported limitations in mobility. The results of this case series show promising outcomes for the use of dry needling in the treatment of chronic lateral hip and thigh pain. Further controlled clinical trials are recommended to determine the effectiveness of adding dry needling as compared to other interventions for chronic lateral hip and thigh pain.
Level of Evidence: Level 4.
Keywords: Dry Needling, hip pain, iliotibial band, trochanteric bursitis
Background and Purpose: Lateral thigh pain, commonly referred to as greater trochanteric pain syn... more Background and Purpose: Lateral thigh pain, commonly referred to as greater trochanteric pain syndrome (GTPS) and/ or iliotibial band syndrome (ITBS) is commonly treated by the physical therapist. Lateral thigh pain is commonly treated by the physical therapist. The sources of lateral thigh pain are commonly attributed to GTPS and/ or ITBS though various pathologies may contribute to this pain, of which trigger points (TrPs) may be an etiology. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain to improve range of motion/ motor control dysfunction. This can assist with facilitation of return to prior level of function. The purpose of this case report is to report the outcomes of a patient with lateral hip and thigh pain treated with DN as a primary intervention strategy. Case Description: The subject was an active 78-year-old female recreational walker who was referred to physical therapy for chronic left lateral hip and thigh pain of greater than one-year duration without a clear mechanism of injury. She had a history of previous physical therapy treatment for the same condition, and previous therapeutic intervention strategies were effective for approximately two to three months duration prior to return of pain symptoms. Physical examination supported a diagnosis of GTPS/ ITBS. Subjective reports denoted sleep deficit due to pain lying on the left side at night and difficulty walking more than five minutes. Objective findings included decreased strength of the hip musculature and reproduction of pain symptoms upon flat palpation in specific locations throughout the lateral hip and thigh regions. She was treated for eight weeks using only DN to determine the effectiveness of DN as a primary intervention strategy, as previous physical therapy interventions were inconsistent and were only beneficial in the short-term. Outcomes: Clinically meaningful improvements were noted in disability and pain, as measured by the Lower Extremity Functional Scale and Quadruple Visual Analog Scale. Improvement in strength was not an objective measure being assessed, however, lower extremity strength improvement was noted upon final physical examination. This case report focused on pain reduction for improved function rather than strength improvement. Improvements in pain and disability were subjectively reported. The subject was able to lie on her left side at night, which improved her ability to sleep. She was also able to tolerate walking approximately twenty to thirty minutes for improved community ambulation needs. Discussion: This case report presents promising outcomes for the use of DN in the treatment of chronic lateral hip and thigh pain. Further research is recommended to determine if DN is clinically beneficial independent of other therapeutic interventions such as exercise, myofascial release/ massage, non-thrust mobilization, or manipulation. Level of evidence: Level 4 Key words: Dry needling; hip pain; iliotibial band; trochanteric bursitis
Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have bee... more Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have been studied as a source of neuromusculoskeletal pain, though the ability of clinicians to accurately locate a TrP is not well supported. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain thereby facilitating return to prior level of function. The purpose of this case report is to report the outcomes of DN as a primary treatment intervention for acute, non-specific cervical region pain.
Background and Purpose:
Chronic lateral hip and thigh pain is regularly treated by the physical ... more Background and Purpose: Chronic lateral hip and thigh pain is regularly treated by the physical therapist. Many issues can cause pain in this region, and trigger points may contribute to pain. Dry Needling (DN) is an intervention used by physical therapists where a monofilament needle is inserted into soft tissue to reduce pain thereby facilitating return to prior level of function. The purpose of this case series is to report the outcomes of DN and conventional physical therapy as a treatment intervention for subjects with chronic lateral hip and thigh pain.
Case Descriptions: Four subjects with chronic lateral hip and thigh pain attended between four and eight sixty-minute sessions of dry needling and stretching/ strengthening activities over a four to eight week intervention course. Outcomes were tested at baseline and upon completion of therapy. A long-term follow up averaging 12.25 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Lower Extremity Functional Scale (LEFS).
Outcomes: The LEFS and VAS indicated clinically meaningful improvements in disability and pain in the short term and upon long term follow up for each subject. The LEFSmean for the four subjects improved from 50.75 at baseline to 66.75 at the completion of treatment. At long-term follow-up, the LEFSmean was 65.50. Each subject met the minimal clinically important difference (MCID) and minimal detectable change (MDC) for the LEFS and the VAS. The VAS was broken down into best (VASB), current (VASC), and worst (VASW) rated pain levels and averaged between the four subjects. The VASB improved from 20 mm at the initial assessment to 0 mm upon completion of the intervention duration. The VASC improved from 25.75 mm to 11.75 mm, and the VASW improved from 85 mm to 32.5 mm. At the long-term follow up (average 12.25 months), the VASB, VASC, and VASW scores were 0 mm, 14.58 mm, and 43.75 mm respectively.
Discussion: Clinically meaningful improvements in pain and disability were noted. Subjects reported improved sleep and functional mobility, which were commensurate with their different age ranges and initial reported limitations in mobility. The results of this case series show promising outcomes for the use of dry needling in the treatment of chronic lateral hip and thigh pain. Further controlled clinical trials are recommended to determine the effectiveness of adding dry needling as compared to other interventions for chronic lateral hip and thigh pain.
Level of Evidence: Level 4.
Keywords: Dry Needling, hip pain, iliotibial band, trochanteric bursitis
Background and Purpose: Lateral thigh pain, commonly referred to as greater trochanteric pain syn... more Background and Purpose: Lateral thigh pain, commonly referred to as greater trochanteric pain syndrome (GTPS) and/ or iliotibial band syndrome (ITBS) is commonly treated by the physical therapist. Lateral thigh pain is commonly treated by the physical therapist. The sources of lateral thigh pain are commonly attributed to GTPS and/ or ITBS though various pathologies may contribute to this pain, of which trigger points (TrPs) may be an etiology. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain to improve range of motion/ motor control dysfunction. This can assist with facilitation of return to prior level of function. The purpose of this case report is to report the outcomes of a patient with lateral hip and thigh pain treated with DN as a primary intervention strategy. Case Description: The subject was an active 78-year-old female recreational walker who was referred to physical therapy for chronic left lateral hip and thigh pain of greater than one-year duration without a clear mechanism of injury. She had a history of previous physical therapy treatment for the same condition, and previous therapeutic intervention strategies were effective for approximately two to three months duration prior to return of pain symptoms. Physical examination supported a diagnosis of GTPS/ ITBS. Subjective reports denoted sleep deficit due to pain lying on the left side at night and difficulty walking more than five minutes. Objective findings included decreased strength of the hip musculature and reproduction of pain symptoms upon flat palpation in specific locations throughout the lateral hip and thigh regions. She was treated for eight weeks using only DN to determine the effectiveness of DN as a primary intervention strategy, as previous physical therapy interventions were inconsistent and were only beneficial in the short-term. Outcomes: Clinically meaningful improvements were noted in disability and pain, as measured by the Lower Extremity Functional Scale and Quadruple Visual Analog Scale. Improvement in strength was not an objective measure being assessed, however, lower extremity strength improvement was noted upon final physical examination. This case report focused on pain reduction for improved function rather than strength improvement. Improvements in pain and disability were subjectively reported. The subject was able to lie on her left side at night, which improved her ability to sleep. She was also able to tolerate walking approximately twenty to thirty minutes for improved community ambulation needs. Discussion: This case report presents promising outcomes for the use of DN in the treatment of chronic lateral hip and thigh pain. Further research is recommended to determine if DN is clinically beneficial independent of other therapeutic interventions such as exercise, myofascial release/ massage, non-thrust mobilization, or manipulation. Level of evidence: Level 4 Key words: Dry needling; hip pain; iliotibial band; trochanteric bursitis
Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have bee... more Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have been studied as a source of neuromusculoskeletal pain, though the ability of clinicians to accurately locate a TrP is not well supported. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain thereby facilitating return to prior level of function. The purpose of this case report is to report the outcomes of DN as a primary treatment intervention for acute, non-specific cervical region pain.
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Papers by Ron Pavkovich
Chronic lateral hip and thigh pain is regularly treated by the physical therapist. Many issues can cause
pain in this region, and trigger points may contribute to pain. Dry Needling (DN) is an intervention used by physical therapists
where a monofilament needle is inserted into soft tissue to reduce pain thereby facilitating return to prior level of function. The purpose of this case series is to report the outcomes of DN and conventional physical therapy as a treatment intervention for
subjects with chronic lateral hip and thigh pain.
Case Descriptions:
Four subjects with chronic lateral hip and thigh pain attended between four and eight sixty-minute sessions
of dry needling and stretching/ strengthening activities over a four to eight week intervention course. Outcomes were tested at
baseline and upon completion of therapy. A long-term follow up averaging 12.25 months (range 3 to 20 months) was also performed.
The outcome measures included the Visual Analog Scale (VAS) and the Lower Extremity Functional Scale (LEFS).
Outcomes:
The LEFS and VAS indicated clinically meaningful improvements in disability and pain in the short term and upon long
term follow up for each subject. The LEFSmean for the four subjects improved from 50.75 at baseline to 66.75 at the completion of treatment. At long-term follow-up, the LEFSmean was 65.50. Each subject met the minimal clinically important difference (MCID) and
minimal detectable change (MDC) for the LEFS and the VAS. The VAS was broken down into best (VASB), current (VASC), and worst
(VASW) rated pain levels and averaged between the four subjects. The VASB improved from 20 mm at the initial assessment to 0 mm
upon completion of the intervention duration. The VASC improved from 25.75 mm to 11.75 mm, and the VASW improved from 85 mm to 32.5 mm. At the long-term follow up (average 12.25 months), the VASB, VASC, and VASW scores were 0 mm, 14.58 mm, and 43.75 mm respectively.
Discussion:
Clinically meaningful improvements in pain and disability were noted. Subjects reported improved sleep and functional
mobility, which were commensurate with their different age ranges and initial reported limitations in mobility. The results
of this case series show promising outcomes for the use of dry needling in the treatment of chronic lateral hip and thigh pain.
Further controlled clinical trials are recommended to determine the effectiveness of adding dry needling as compared to other
interventions for chronic lateral hip and thigh pain.
Level of Evidence: Level 4.
Keywords: Dry Needling, hip pain, iliotibial band, trochanteric bursitis
(ITBS) is commonly treated by the physical therapist. Lateral thigh pain is commonly treated by the physical therapist. The sources of lateral thigh
pain are commonly attributed to GTPS and/ or ITBS though various pathologies may contribute to this pain, of which trigger points (TrPs) may be an
etiology. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to
reduce pain to improve range of motion/ motor control dysfunction. This can assist with facilitation of return to prior level of function. The purpose
of this case report is to report the outcomes of a patient with lateral hip and thigh pain treated with DN as a primary intervention strategy.
Case Description: The subject was an active 78-year-old female recreational walker who was referred to physical therapy for chronic left
lateral hip and thigh pain of greater than one-year duration without a clear mechanism of injury. She had a history of previous physical
therapy treatment for the same condition, and previous therapeutic intervention strategies were effective for approximately two to three
months duration prior to return of pain symptoms. Physical examination supported a diagnosis of GTPS/ ITBS. Subjective reports denoted
sleep deficit due to pain lying on the left side at night and difficulty walking more than five minutes. Objective findings included decreased
strength of the hip musculature and reproduction of pain symptoms upon flat palpation in specific locations throughout the lateral hip
and thigh regions. She was treated for eight weeks using only DN to determine the effectiveness of DN as a primary intervention strategy,
as previous physical therapy interventions were inconsistent and were only beneficial in the short-term.
Outcomes: Clinically meaningful improvements were noted in disability and pain, as measured by the Lower Extremity Functional Scale
and Quadruple Visual Analog Scale. Improvement in strength was not an objective measure being assessed, however, lower extremity
strength improvement was noted upon final physical examination. This case report focused on pain reduction for improved function rather
than strength improvement. Improvements in pain and disability were subjectively reported. The subject was able to lie on her left side at
night, which improved her ability to sleep. She was also able to tolerate walking approximately twenty to thirty minutes for improved community
ambulation needs.
Discussion: This case report presents promising outcomes for the use of DN in the treatment of chronic lateral hip and thigh pain. Further
research is recommended to determine if DN is clinically beneficial independent of other therapeutic interventions such as exercise,
myofascial release/ massage, non-thrust mobilization, or manipulation.
Level of evidence: Level 4
Key words: Dry needling; hip pain; iliotibial band; trochanteric bursitis
Chronic lateral hip and thigh pain is regularly treated by the physical therapist. Many issues can cause
pain in this region, and trigger points may contribute to pain. Dry Needling (DN) is an intervention used by physical therapists
where a monofilament needle is inserted into soft tissue to reduce pain thereby facilitating return to prior level of function. The purpose of this case series is to report the outcomes of DN and conventional physical therapy as a treatment intervention for
subjects with chronic lateral hip and thigh pain.
Case Descriptions:
Four subjects with chronic lateral hip and thigh pain attended between four and eight sixty-minute sessions
of dry needling and stretching/ strengthening activities over a four to eight week intervention course. Outcomes were tested at
baseline and upon completion of therapy. A long-term follow up averaging 12.25 months (range 3 to 20 months) was also performed.
The outcome measures included the Visual Analog Scale (VAS) and the Lower Extremity Functional Scale (LEFS).
Outcomes:
The LEFS and VAS indicated clinically meaningful improvements in disability and pain in the short term and upon long
term follow up for each subject. The LEFSmean for the four subjects improved from 50.75 at baseline to 66.75 at the completion of treatment. At long-term follow-up, the LEFSmean was 65.50. Each subject met the minimal clinically important difference (MCID) and
minimal detectable change (MDC) for the LEFS and the VAS. The VAS was broken down into best (VASB), current (VASC), and worst
(VASW) rated pain levels and averaged between the four subjects. The VASB improved from 20 mm at the initial assessment to 0 mm
upon completion of the intervention duration. The VASC improved from 25.75 mm to 11.75 mm, and the VASW improved from 85 mm to 32.5 mm. At the long-term follow up (average 12.25 months), the VASB, VASC, and VASW scores were 0 mm, 14.58 mm, and 43.75 mm respectively.
Discussion:
Clinically meaningful improvements in pain and disability were noted. Subjects reported improved sleep and functional
mobility, which were commensurate with their different age ranges and initial reported limitations in mobility. The results
of this case series show promising outcomes for the use of dry needling in the treatment of chronic lateral hip and thigh pain.
Further controlled clinical trials are recommended to determine the effectiveness of adding dry needling as compared to other
interventions for chronic lateral hip and thigh pain.
Level of Evidence: Level 4.
Keywords: Dry Needling, hip pain, iliotibial band, trochanteric bursitis
(ITBS) is commonly treated by the physical therapist. Lateral thigh pain is commonly treated by the physical therapist. The sources of lateral thigh
pain are commonly attributed to GTPS and/ or ITBS though various pathologies may contribute to this pain, of which trigger points (TrPs) may be an
etiology. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to
reduce pain to improve range of motion/ motor control dysfunction. This can assist with facilitation of return to prior level of function. The purpose
of this case report is to report the outcomes of a patient with lateral hip and thigh pain treated with DN as a primary intervention strategy.
Case Description: The subject was an active 78-year-old female recreational walker who was referred to physical therapy for chronic left
lateral hip and thigh pain of greater than one-year duration without a clear mechanism of injury. She had a history of previous physical
therapy treatment for the same condition, and previous therapeutic intervention strategies were effective for approximately two to three
months duration prior to return of pain symptoms. Physical examination supported a diagnosis of GTPS/ ITBS. Subjective reports denoted
sleep deficit due to pain lying on the left side at night and difficulty walking more than five minutes. Objective findings included decreased
strength of the hip musculature and reproduction of pain symptoms upon flat palpation in specific locations throughout the lateral hip
and thigh regions. She was treated for eight weeks using only DN to determine the effectiveness of DN as a primary intervention strategy,
as previous physical therapy interventions were inconsistent and were only beneficial in the short-term.
Outcomes: Clinically meaningful improvements were noted in disability and pain, as measured by the Lower Extremity Functional Scale
and Quadruple Visual Analog Scale. Improvement in strength was not an objective measure being assessed, however, lower extremity
strength improvement was noted upon final physical examination. This case report focused on pain reduction for improved function rather
than strength improvement. Improvements in pain and disability were subjectively reported. The subject was able to lie on her left side at
night, which improved her ability to sleep. She was also able to tolerate walking approximately twenty to thirty minutes for improved community
ambulation needs.
Discussion: This case report presents promising outcomes for the use of DN in the treatment of chronic lateral hip and thigh pain. Further
research is recommended to determine if DN is clinically beneficial independent of other therapeutic interventions such as exercise,
myofascial release/ massage, non-thrust mobilization, or manipulation.
Level of evidence: Level 4
Key words: Dry needling; hip pain; iliotibial band; trochanteric bursitis