Case Study: Dry Needling for Medial Knee Pain

The Challenge

Knee pain is a widespread and complex problem, and finding solutions for targeted pain treatment and rehabilitation presents a challenge. We set out to discover whether precise muscle dry needling of myofascial trigger points under ultrasound guidance would be an effective treatment for medial knee pain in adults.

Our goal was to restore muscle function and mobility, and improve posture in adults with medial knee pain.

Our Methodology

Study participants were 10 male and 8 female (N=18) adults aged 20-65 presenting with medial knee pain, postural imbalances and low back pain. Patients with rheumatism, background of trauma and/or, advanced knee arthrosis were excluded. All participants underwent a physical exam and posture analysis, and were examined using functional musculoskeletal ultrasound.

Our Examination Results

Our examination detected knee joint effusion in 17 patients, meniscal tears in 12 patients, MCL injury in 9 patients, patellofemoral ligament injury in 3 patients, ACL injury in 2 patients, and lateral muscles dystonia and tight iliotibial bands with patellar instability in 16 patients.

All patients had postural imbalances and multiple MTrPs. Trigger points were detected in multifidus muscles at the lumbar level (L3-5, S1), and localized MTrPs were dominant in the soleus and foot muscles. We also found sacroiliac joint dysfunction, shoulder impingement, and other associated postural abnormalities. Seven patients had sciatic neuropathy.

Myofascial trigger points (MTrPs) were identified via clinical exam, referred pain patterns, and ultrasound imaging.

Our Treatment Approach and Results

We conducted targeted dry needling under ultrasound guidance to release patients’ myofascial trigger points.

Results of dry needling treatment:

  • Mobility was restored in 100% of patients treated
  • 15 patients reported full recovery after dry needling


Medial knee pain is associated with muscular dystonia and postural imbalances. High resolution ultrasound imaging provides a simple and fast approach for identifying patterns in individual patients, and is highly beneficial for guiding targeted dry needling procedures. Ultrasound is a helpful tool for medial knee rehabilitation.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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