What a great combination of therapies for chronic ankle instability.

Background and objective :

TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone.

Inclusive criteria :

(1) age between 18 and 50 years, (2) history of at least one ankle sprain, (3) at least one episode of giving away in the previous 6 months, (4) ankle pain of intensity > 3 points on an 11-point numerical pain rate scale (NPRS), and (5) score of 25 or less on the Cumberland Ankle Instability Tool [18, 19]. In addition, participants also had to be physically active, defined as participating in vigorous physical activity at least 20 min a day, 3 times a week [20]. Participants were allowed to continue their regular physical activities during the study period.

Limitation of study:

(1) fracture in the lower extremity, (2) history of surgery in the lower extremity, (3) any concomitant lower extremity pathology, for example, vascular disease and osteoarthritis, (4) pregnancy, (5) regular use of medication, or (6) previous physical therapy interventions received on the lower extremity within the previous 6 months.


This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

Implementation in clinical practice…..


Ankle instability may occurs due to late firing of peronei during walking or running. Therefore it may go into relative flexibility. Which gradually leads to decrease the Proprioception .

Did you notice they used the trigger points in the peroneus longs muscle to needle? Though they didn’t say it,  how this muscle influences both frontal and saggital plan stability.

For instance, restoration of the length of the muscle sarcomeres of the lateral peroneus may improve motor output of the muscle explaining the improvement in function, whereas the decrease in peripheral nociception could be related to the decrease in pain. It may decerease latency of peronei .

TrP-DN applied on the lateral peroneus muscles before the beginning of proprioceptive/strengthening exercises can improve the motor output of this muscle.

From this study , we can conclude that when we find ankle instability ,check for flexibility of peronei. Hence, TrP-DN along with propriocpetion exercise should included.

Guide for Proprioception exercise:

– to move from a position of nonweight bearing to weight bearing,
-bilateral stance to unilateral stance,
-eyes open to eyes closed,
-firm surface to soft surface, uneven or moving surface.

How to release trigger point a simple step:

Once the TrP is located with flat palpation in the lateral peroneus muscle, the overlying skin is cleaned with alcohol. The needle is inserted, penetrating the skin 10–15 mm into the TrP until the first local twitch response is obtained. It is suggested that local twitch responses should be elicited during TrP-DN for a proper and successful technique. Once the first local twitch response is obtained, the needling is moved up and down (2 to 3 mm vertical motions with no rotations) at approximately 1 Hz for 30–45 seconds.


Pic courtesy : media.lidn.com


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