{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:31:30Z","timestamp":1792805490901,"version":"4.5.0"},"reference-count":57,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Asia University Hospital","award":["11151005"],"award-info":[{"award-number":["11151005"]}],"id":[{"id":"https:\/\/ror.org\/041pzja41","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: Fu\u2019s subcutaneous needling (FSN) is a new acupuncture technique that produces a long-lasting effect in soft-tissue injuries. In patients with degenerative knee osteoarthritis (OA), myofascial trigger points (MTrPs) are common in the lower-limb muscles. In this randomized clinical trial, we evaluated the immediate, 1-week and 2-week effectiveness of FSN therapy in the treatment of degenerative knee OA. Patients and methods: We randomly divided 32 patients with knee OA into the FSN group (mean age: 65.73 \u00b1 6.79 years) or the transcutaneous electrical nerve stimulation (TENS) group (mean age: 62.81 \u00b1 5.72 years). The pressure pain threshold (PPT) and tissue hardness (TH) of the muscle and tendon attachment sites, knee range of motion, and physical ability (average walking speed) were measured. The subjective pain intensity index, Western Ontario and McMaster Universities OA Index (WOMAC), and Lequesne index were used to determine the efficacy of FSN on MTrP-induced soft-tissue pain compared with that of TENS. Results: A significantly greater improvement in pain qualities in the VAS (p &lt; 0.05) was found in the FSN group. Moreover, in muscle and tendon qualities (including PPT and TH), a significant difference in the PPT of the quadriceps muscle (p &lt; 0.05) was also observed among the immediate treatments in the FSN group. As for the functional index questionnaire assessment, the FSN group exhibited significant improvements among the immediate, 1-week and 2-week efficacies in terms of WOMAC (p &lt; 0.05) and Lequesne index scores (p &lt; 0.05). Conclusion: FSN was effective in treating soft-tissue pain in degenerative knee OA in terms of alleviating pain, strengthening walking ability, and improving overall functional performance. Pain relief was the primary benefit of FSN and a significant correlation between pain relief and knee joint mobility improvement was found. Trial registration: ClinicalTrials.gov Protocol Registration and Results System (registration number: NCT04356651).<\/jats:p>","DOI":"10.3390\/jcm11237184","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T06:29:09Z","timestamp":1670221749000},"page":"7184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Efficacy of Fu\u2019s Subcutaneous Needling in Treating Soft Tissue Pain of Knee Osteoarthritis: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"11","author":[{"given":"Po-En","family":"Chiu","sequence":"first","affiliation":[{"name":"Department of Chinese Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505029, Taiwan"},{"name":"Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhonghua","family":"Fu","sequence":"additional","affiliation":[{"name":"Institute of Fu\u2019s Subcutaneous Needling, Beijing University of Chinese Medicine, Beijing 100029, China"},{"name":"Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Sun","sequence":"additional","affiliation":[{"name":"Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, China"},{"name":"Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China"},{"name":"Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510260, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guan-Wei","family":"Jian","sequence":"additional","affiliation":[{"name":"Graduate Institute of Acupuncture Science, China Medical University, Taichung 404333, Taiwan"},{"name":"Department of Chinese Medicine, Sinying Hospital, Ministry of Health and Welfare, Tainan 730020, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Te-Mao","family":"Li","sequence":"additional","affiliation":[{"name":"School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-6225","authenticated-orcid":false,"given":"Li-Wei","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan"},{"name":"Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1159\/000357756","article-title":"Clinical imaging assessments of knee osteoarthritis in the elderly: A mini-review","volume":"60","author":"Wick","year":"2014","journal-title":"Gerontology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.7812\/TPP\/16-183","article-title":"Knee osteoarthritis: A primer","volume":"21","author":"Lespasio","year":"2017","journal-title":"Perm. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","first-page":"646","article-title":"Burden of major musculoskeletal conditions","volume":"81","author":"Woolf","year":"2003","journal-title":"Bull. World Health Organ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9332","DOI":"10.1073\/pnas.1703856114","article-title":"Knee osteoarthritis has doubled in prevalence since the mid-20th century","volume":"114","author":"Wallace","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1002\/acr.22897","article-title":"Number of persons with symptomatic knee osteoarthritis in the US: Impact of race and ethnicity, age, sex, and obesity","volume":"68","author":"Deshpande","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_7","first-page":"42","article-title":"Evolution of osteoarthritis treatment: Mesenchymal stem cells of autologous fat","volume":"63","author":"Zhu","year":"2019","journal-title":"J. Taipei Med. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.jbmt.2017.03.025","article-title":"A myofascial component of pain in knee osteoarthritis","volume":"21","author":"Dor","year":"2017","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.berh.2011.11.008","article-title":"Osteoarthritis","volume":"25","author":"Hunter","year":"2011","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1148\/radiol.2393050253","article-title":"Osteoarthritis of the knee: Association between clinical features and MR imaging findings","volume":"239","author":"Kornaat","year":"2006","journal-title":"Radiology"},{"key":"ref_11","first-page":"349","article-title":"Is a Combination of Exercise and Dry Needling Effective for Knee OA?","volume":"21","year":"2020","journal-title":"Pain Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2165\/00003495-200464010-00004","article-title":"Myofascial pain disorders: Theory to therapy","volume":"64","author":"Wheeler","year":"2004","journal-title":"Drugs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"705327","DOI":"10.1155\/2012\/705327","article-title":"Probable mechanisms of needling therapies for myofascial pain control","volume":"2012","author":"Chou","year":"2012","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"39","DOI":"10.7603\/s40681-014-0013-2","article-title":"Needling therapy for myofascial pain: Recommended technique with multiple rapid needle insertion","volume":"4","author":"Chou","year":"2014","journal-title":"BioMedicine"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Navarro-Santana, M.J., Sanchez-Infante, J., Fern\u00e1ndez-de-Las-Pe\u00f1as, C., Cleland, J.A., Mart\u00edn-Casas, P., and Plaza-Manzano, G. (2020). Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: An updated systematic review and meta-analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103300"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1089\/acm.2007.0810","article-title":"Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch\u2019s analysis revisited","volume":"14","author":"Dorsher","year":"2008","journal-title":"J. Altern. Complement. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e15964","DOI":"10.1097\/MD.0000000000015964","article-title":"Traditional Chinese medicine therapy reduces the risk of total knee replacement in patients with knee osteoarthritis","volume":"98","author":"Lo","year":"2019","journal-title":"Medicine"},{"key":"ref_18","unstructured":"Fu, Z.H. (2016). The Foundation of Fu\u2019s Subcutaneous Needling, People\u2019s Medical Publishing House Co., Ltd."},{"key":"ref_19","first-page":"45","article-title":"Fu\u2019s subcutaneous needling, modern acupuncture","volume":"19","author":"Li","year":"2016","journal-title":"J. Chin. Med. Assoc. Acupunct."},{"key":"ref_20","unstructured":"Fu, Z., and Chou, L.W. (2018). Chapter 16 Fu\u2019s Subcutaneous Needling, Trigger Point Dry Needling: An Evidence and Clinical-Based Approach, Elsevier Health Sciences. [2nd ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.joca.2010.06.001","article-title":"Association of radiographic and symptomatic knee osteoarthritis with health-related quality of life in a population-based cohort study in Japan: The ROAD study","volume":"18","author":"Muraki","year":"2010","journal-title":"Osteoarthr. Cartil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3163","DOI":"10.2147\/JPR.S333299","article-title":"Evaluating effectiveness of Fu\u2019s subcutaneous needling for the pain nature and quality of life in patients with knee osteoarthritis: A study protocol of randomized clinical trial","volume":"14","author":"Chiu","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/0304-3959(87)90089-3","article-title":"Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold","volume":"30","author":"Fischer","year":"1987","journal-title":"Pain"},{"key":"ref_24","first-page":"836","article-title":"Pressure threshold meter: Its use for quantification of tender spots","volume":"67","author":"Fischer","year":"1986","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Han, T.I., Hong, C.Z., Kuo, F.C., Hsieh, Y.L., Chou, L.W., and Kao, M.J. (2012). Mechanical pain sensitivity of deep tissues in children\u2014Possible development of myofascial trigger points in children. BMC Musculoskelet. Disord., 13.","DOI":"10.1186\/1471-2474-13-13"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"94","DOI":"10.37190\/ABB-01502-2019-02","article-title":"Absolute and relative reliability of several measures of static postural stability calculated using a GYKO inertial sensor system","volume":"22","author":"Jaworski","year":"2020","journal-title":"Acta. Bioeng. Biomech."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102091","DOI":"10.1016\/j.msksp.2019.102091","article-title":"Reliability and validity of the Microgate Gyko for measuring range of motion of the low back","volume":"45","author":"Hamersma","year":"2020","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1365-2516.2010.02399.x","article-title":"Range of motion measurements: Reference values and a database for comparison studies","volume":"17","author":"Soucie","year":"2011","journal-title":"Haemophilia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"743843","DOI":"10.1155\/2013\/743843","article-title":"Flexibility of older adults aged 55-86 years and the influence of physical activity","volume":"2013","author":"Stathokostas","year":"2013","journal-title":"J. Aging Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s40634-018-0161-5","article-title":"Accuracy and reliability of knee goniometry methods","volume":"5","author":"Hancock","year":"2018","journal-title":"J. Exp. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.archger.2012.03.005","article-title":"Quadriceps muscle tone, elasticity and stiffness in older males: Reliability and symmetry using the MyotonPRO","volume":"55","author":"Aird","year":"2012","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.jshs.2015.12.001","article-title":"Validity and reliability of three methods of stiffness assessment","volume":"5","author":"Pruyn","year":"2016","journal-title":"J. Sport Health Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1589\/jpts.28.1339","article-title":"Immediate effects of kinematic taping on lower extremity muscle tone and stiffness in flexible flat feet","volume":"28","author":"Wang","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1002\/acr.22631","article-title":"Validation of the chinese western ontario and mcmaster universities osteoarthritis index in patients from mainland china with osteoarthritis of the knee","volume":"67","author":"Symonds","year":"2015","journal-title":"Arthritis Care Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1053\/joca.1997.0097","article-title":"Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index and a self-report format of the self-administered Lequesne-Algofunctional index in patients with knee and hip osteoarthritis","volume":"6","author":"Stucki","year":"1998","journal-title":"Osteoarthr. Cartil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2217\/pmt.14.13","article-title":"Using TENS for pain control: The state of the evidence","volume":"4","author":"Vance","year":"2014","journal-title":"Pain Manag."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Osiri, M., Welch, V., Brosseau, L., Shea, B., McGowan, J.L., Tugwell, P., and Wells, G.A. (2000). Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database Syst. Rev., CD002823.","DOI":"10.1002\/14651858.CD002823"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.joca.2014.11.014","article-title":"Electrical stimulation for pain relief in knee osteoarthritis: Systematic review and network meta-analysis","volume":"23","author":"Zeng","year":"2015","journal-title":"Osteoarthr. Cartil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"7964897","DOI":"10.1155\/2019\/7964897","article-title":"Efficacy and safety of a stimulator using low-intensity pulsed ultrasound combined with transcutaneous electrical nerve stimulation in patients with painful knee osteoarthritis","volume":"2019","author":"Kim","year":"2019","journal-title":"Pain Res. Manag."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4103\/2231-4040.191414","article-title":"Interim analysis: A rational approach of decision making in clinical trial","volume":"7","author":"Kumar","year":"2016","journal-title":"J. Adv. Pharm. Technol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"7294","DOI":"10.1038\/s41598-020-64176-0","article-title":"Transcutaneous electrical nerve stimulation improves stair climbing capacity in people with knee osteoarthritis","volume":"10","author":"Iijima","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/PHM.0000000000000876","article-title":"Immediate effects of simultaneous application of transcutaneous electrical nerve stimulation and ultrasound phonophoresis on active myofascial trigger points","volume":"97","author":"Takla","year":"2018","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_43","unstructured":"Chen, L.L., and Cheng, T.O. (2013). Fu\u2019s subcutaneous needling, a modern style of ancient acupuncture?. Acupuncture in Modern Medicine [Internet], IntechOpen."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1089\/acm.2006.6125","article-title":"Fu\u2019s subcutaneous needling: Possible clinical evidence of the subcutaneous connective tissue in acupuncture","volume":"13","author":"Fu","year":"2007","journal-title":"J. Altern. Complement. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1002\/acr.21655","article-title":"Association of slower walking speed with incident knee osteoarthritis-related outcomes","volume":"64","author":"Purser","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.joca.2020.12.024","article-title":"Immediate outcomes following the GLA:D\u00ae program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis","volume":"29","author":"Roos","year":"2021","journal-title":"Osteoarthr. Cartil."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"493","DOI":"10.3889\/oamjms.2018.126","article-title":"Physiotherapy effects in gait speed in patients with knee osteoarthritis","volume":"6","author":"Tani","year":"2018","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_48","first-page":"13","article-title":"Dynamic stretching has sustained effects on range of motion and passive stiffness of the hamstring muscles","volume":"18","author":"Iwata","year":"2019","journal-title":"J. Sports Sci. Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Chen, C.H., Xin, Y., Lee, K.W., Lin, M.J., and Lin, J.J. (2018). Acute effects of different dynamic exercises on hamstring strain risk factors. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0191801"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1136\/bjsports-2019-100727","article-title":"Infographic. Therapeutic exercise relieves pain and dose not harm knee cartilage nor trigger inflammation","volume":"54","author":"Bricca","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Plaut, S. (2022). Scoping review and interpretation of myofascial pain\/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263087"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2334\/josnusd.17-0453","article-title":"Change in muscle hardness after trigger point injection and physiotherapy for myofascial pain syndrome","volume":"61","author":"Sekine","year":"2019","journal-title":"J. Oral Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2334\/josnusd.15-0491","article-title":"Headache attributed to temporomandibular disorders and masticatory myofascial pain","volume":"58","author":"Hara","year":"2016","journal-title":"J. Oral Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.jclinepi.2005.11.019","article-title":"Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients","volume":"59","author":"Terwee","year":"2006","journal-title":"J. Clin. Epidemiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Bedson, J., and Croft, P.R. (2008). The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-116"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1016\/j.apmr.2007.07.020","article-title":"Identification and quantification of myofascial taut bands with magnetic resonance elastography","volume":"88","author":"Chen","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Fitridge, R., and Thompson, M. (2011). Pathophysiology of reperfusion injury. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists [Internet], University of Adelaide Press.","DOI":"10.1017\/UPO9781922064004"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:33:05Z","timestamp":1760146385000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":57,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11237184"],"URL":"https:\/\/doi.org\/10.3390\/jcm11237184","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,2]]}}}