title: Autonomic responses to ultrasound-guided percutaneous needle electrolysis of the patellar tendon in healthy male footballers.
abstract: BACKGROUND
  Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach, which involves the application of a galvanic current via an acupuncture needle. As in any procedure involving needling, vagal reactions have been reported during PNE.
  
  
  OBJECTIVE
  To examine for changes in autonomic activity during the US-guided PNE technique on healthy patellar tendons by measurement and analysis of heart rate variability (HRV).
  
  
  METHODS
  Twenty-two male footballers were randomly allocated to: a control group (11 players), for whom HRV was recorded for 10 min, both at rest and during an exhaustive US examination of the patellar tendon and adjacent structures; and an experimental group (11 players), for whom HRV was recorded for 10 min, both at rest and during application of US-guided PNE on the patellar tendon. The following HRV parameters were assessed: mean NN interval, mean heart rate, time domain parameters (SDNN, rMSSD, pNN50), diameters of the Poincaré plot (SD1, SD2), stress score, and sympathetic/parasympathetic ratio.
  
  
  RESULTS
  There were no differences between groups in any baseline measurements, nor were there any significant differences between control group measurements (baseline vs intervention). The experimental group exhibited statistically significant increases in SDNN/SD1 (p=0.02/p=0.03) and SD2 (p=0.03), indicating increased parasympathetic and decreased sympathetic activity, respectively.
  
  
  CONCLUSIONS
  US-guided PNE was associated with an autonomic imbalance characterised by greater parasympathetic activity, which could potentially result in a vasovagal reaction. Care should be taken to monitor for adverse reactions during US-guided PNE and simple HRV indicators may have a role in early detection.
authors.affiliation: Department of Physiotherapy, University of Seville. Avicena Street, Seville, Spain.
authors.forename: Blanca
authors.identifier: http://orcid.org/0000-0001-8499-9760
authors.initials: B
authors.lastname: de la Cruz Torres
authors.affiliation: Department of Physiotherapy, University of Seville. Avicena Street, Seville, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Albornoz Cabello
authors.affiliation: Department of Physiotherapy, University of Seville. Avicena Street, Seville, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: García Bermejo
authors.affiliation: Department of Sport and Computing, Pablo de Olavide University, Seville, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Naranjo Orellana
mesh_terms: D001341:Autonomic Nervous System / Q000502:physiology; D004572:Electrolysis / Q000379:methods / Q000523:psychology; D006339:Heart Rate; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000294:innervation; D018084:Ultrasonography, Interventional / Q000523:psychology
keywords: SPORTS MEDICINE; ULTRASONOGRAPHY