Case reportMultimodal Care in the Management of a Patient With Chronic Tendinopathy of the Biceps Femoris: A Case Report
Introduction
The American Academy of Pain Medicine estimated that 100 million people experience chronic pain.1 In 2011, the treatment of chronic pain cost between $261 billion and $300 billion in the United States.1 According to the Centers for Disease Control, doctors prescribed 259 million pain medications in 2012.2
An array of treatment strategies is available for patients with chronic pain, and these range from conservative therapies, including dry needling, auricular acupuncture, massage, or physical therapy, to more invasive options, such as surgery or injections. Several acupuncture techniques and dry needling have demonstrated efficacy for the treatment of certain types of chronic pain.3, 4, 5 These modalities may be used in combination with exercises to supplement therapy. A case report described treatment of 2 runners with proximal biceps femoris tendinopathy with the use of a combination of eccentric loading and lumbopelvic stabilization exercises and dry needling. The therapy was administered once a week for 8 to 10 weeks, and clinical improvements were noted in pain, tenderness, and range of motion (ROM).6 Another example was the use of dry needling with stretching and strengthening exercises to treat chronic pain of the hip and thigh. Pain and functionality were improved according to the Lower Extremity Functional Scale and the Visual Analog Scale.7 The combination of these therapies was determined to be effective for treating chronic pain.7
The physiological effects of dry needling may manifest locally in tissues. Puncturing the epidermis with these minimally invasive needles has been shown to prevent collagen degradation by inhibiting matrix metalloproteinase activity. Matrix metalloproteinase is involved in the degradation of tissue resulting from damage. Inhibiting the activity of matrix metalloproteinase promotes tissue healing and repair.5 Evidence suggests that dry needling may downregulate the inflammatory cascade. It has the ability to inhibit the expression of nuclear-factor KB, which disrupts the production of arachidonic acid, thus preventing the generation of inflammatory prostaglandins, leukotrienes, and thromboxanes.8 In addition, penetration of the tissue reduces inflammatory mediators tumor necrosis factor-α and interleukin-6.8
Available research data emphasize the potential benefit of dry needling for treating chronic pain. However, most studies utilizing dry needling for treating chronic pain were focused on musculoskeletal conditions. Information pertaining to the effectiveness of dry needling for tendinopathies is limited. In addition, only a minimal amount of information exists to validate the use of auricular therapy for pain management. In a study including 38 patients, true or sham auricular therapy was provided while patients were riding in an ambulance after a hip fracture. In patients receiving true auriculotherapy, less pain was observed in conjunction with lower levels of anxiety and a reduced heart rate, as well as overall satisfaction with treatment.4
The purpose of this case report is to describe the combination of dry needling and auricular acupuncture in conjunction with core exercises and light aerobic activity for the treatment of chronic tendinopathy of the right biceps femoris muscle.
Section snippets
History
A 30-year-old white female sought treatment for pain of her right biceps femoris muscle at its origin on the ischium. She noted that the pain had begun 18 months earlier. The onset of the pain was gradual. Pain would start during training, after running, or after cycling for a prolonged period. No trauma was associated with her injury. The pain intensified and eventually became constant during activity. The patient continued her training regimen and competed in the triathlon despite the
Discussion
There is limited data from research pertaining to the treatment of a tendinopathy of the biceps femoris using dry needling. One published study had analyzed the treatment of biceps femoris tendinopathy utilizing dry needling. The study reported by Jayaseelan et al. consisted of 2 case reports, which were discussed in the introduction section of the paper. The overall results of the case reports by Jayaseelan et al. and this case report have similar findings that demonstrate the effectiveness of
Conclusions
This patient responded positively to treatment of chronic tendinopathy with dry needling in combination with auricular acupuncture, core exercises, and light aerobic activity. This therapeutic approach may help to alleviate pain and could be helpful in other cases of tendinopathy. However, with this treatment strategy, the exact impact of each individual treatment modality is difficult to ascertain.
Funding Sources and Potential Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): B.R.M.
Design (planned the methods to generate the results): B.R.M.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): B.R.M.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): B.R.M.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): B.R.M.
Literature search (performed
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