Sports Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 270-275 (2017)

Comparative effect of micro needling and its impact on

training in water during the treatment of women with

varicose legs

Vahideh Riyahi

, Bijan Goodarzi

, Vahid Riyahi

and Fatemeh Mohamadpour Vahedi

Master in Physical Education, Minister of Education, Maragheh, Iran

Assisstant Professor, Department of Physical Education and Sports Sciences, Borujerd Branch, Islamic Azad

University, Borujerd, Iran

Master in Physical Education, Minister of Education, Maragheh, Iran

Director Ministry of Education, Maragheh, Iran

ABSTRACT

The present study aims to compare the effect of a period of micro needling and impact of training in water in the

treatment of women with varicose legs. For this purpose, 30 women were selected as subjects with varicose veins

of the lower limb. After randomization of subjects into three groups of 10 people, for 20 weeks, a meeting every 4

weeks and a total of 5 sessions using micro needling and training in water was conducted on patients. The control

group did not have any therapeutic interventions. To analyze the data, paired and independent t-test were used at

a signi cance level of 05/0> P. The  ndings have shown that among the measured values the improvement index

before and after the test for micro needling signi cantly increases and decreases respectively 05/0> P. The results

showed that the use of micro needling can be used as a safe and effective treatment in people with varicose veins

of the lower body. The study showed a 76 percent reduction in the size of the ankle after a week of treatment of the

groups receiving training in water.

KEY WORDS: VARICOSE VEINS, MICRO NEEDLING, HORSE CHESTNUT

270

ARTICLE INFORMATION:

Received 1

March, 2017

Accepted after revision 2

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

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Online Contents Available at: http//www.bbrc.in/

Vahideh Riyahi et al.

INTRODUCTION

Varicose veins originating from the Latin root Varix

means twisted, and it refers to swollen vein or dilate

veins. Varicose veins, is the most common human vascu-

lar disease that affects about 10-20% of the population.

Varicose veins are veins long, dilated and twisted and is

often seen at the interior surfaces of the lower limbs. The

highest prevalence of varicose veins is estimated among

women aged 40-49 years. Varicose veins are large, fully

bulged and noticeable and sometimes palpable and

dilated and elongated, and sometimes have more than

4 mm diameter. Swollen and spider web-like Varicose

veins are very common (Harrie & Kendall, 2014).

More than 40 percent of women over 50 suffer from

the disease. Varicose veins are super cial veins, dilated

and zigzagged due to structural defects and performance

of the saphenous veins, or due to the inherent weakness

of the vein wall or rarely due to Arteriovenous  stu-

las. More than 20 million adult Americans are suffering

from varicose vein disease. The disease causes a feeling

of illness or nausea and as a result reduces the normal

functions of the patient. These veins are related to leg

swelling, pain, dermatitis, phlebitis and ulcers. Patients

with venous failure often complain of pain in their legs

that worsen with prolonged standing and is relieved by

elevating the feet. In the examination of shank diam-

eter, edema of super cial varicose veins and erythema,

dermatitis, hyperpigmentation can be seen in the lower

leg and the skin near the external ankle might become

ulcerous .Varicose veins are mostly asymptomatic and

only the aesthetic aspects require medical attention. If

symptomatic, the pain, fullness and diffused non-spe-

ci c heaviness are felt in the legs, especially after stand-

ing a long time. Sometimes swelling in the ankles and

bulged vessels can be seen in the feet (Chung et al., 2000

Harrie & Kendall, 2014).

Avoiding long time standing or sitting position,

avoiding long-time exposure of legs in the sun and heat

or prolonged contact with garter or belt, avoidance of

continuous wearing of strip (band) or stockings, avoid-

ing simple sugars and lipids and the use of medications

such as  avonoid derivatives, sodium morrhuate are

among the methods of reducing the symptoms of vari-

cose veins(Stiegmann, Sun, & Hammond, 1988) .

Microneedling is a method recently used for skin dis-

eases. Microneedling is a device for general skin nee-

dling which has a comparable impact with laser treat-

ments and chemical peelings. This device can be used

exclusively or as a complement to other treatment meth-

ods. . The disposable needles’ points are short and tiny, it

includes 12 microneedles that should be discarded after

each treatment. For treatment, needle penetration depth

must be between 25% to 2/5 mm set with a speed of

25 beats per second and beat for 90 beats per seconds

which  nally between 300 and 1,000 tiny holes in sec-

onds are created in the surface. Microneedling is used to

stimulate the skin to make natural collagen, (Harrie &

Kendall, 2014).

Furthermore, treatment with this device helps pen-

etration and absorption of drugs to the skin, skin reju-

venation and wrinkles, acne scars healing, improvement

of body craze and the overall appearance of the skin

and shrinkage of the size of the pores. Backlog and

increasing the elasticity of the skin, new collagen pro-

duction, surface and deep wrinkles reduction, improving

crazes, and improving decrements of pigmented lesions’

peneteration ,materials, creams and vitamins to the skin

after treatment with microneedling can be named as the

advantages of microneedling (Van Stiegmann & Goff,

1988)

Research has shown that many patients with varicose

veins can control their disease through regular exercise,

excess weight loss, self-care behavior, and drug con-

trol. In this regard, since the use of drugs in most cases

is expensive, invasive, and associated with many side

effects, physical activity must be considered as the focus

of prevention and management of disease(Carr, 2006).

Regular exercise stimulates blood circulation, improves

the muscles power, and helps prevent varicose veins.

On the other hand, intense aerobic activity, running,

cycling, or any other strenuous activity may lead to

increased blood pressure in the legs and intensify vari-

cose veins (Gloviczki & Yao 2001 and Goldman, 2002).

Hence, one of the ways that can lead to this type of

activity is activity in water. Varicose veins are caused

when the blood accumulates in the veins and blood  ow

is impaired. Aquatic exercise stimulates blood  ow and

reduces swelling veins. Soft pressure of water helps the

blood move in the veins, and touch receptors located in

the skin reduce irritation and sensitivity to pain(Diehm

& Diehm, 2002). Water buoyancy reduces the weight

thus provides easy mobility in water for motor impaired

people. Moreover, water resistance properties can cre-

ate a form of resistance training conditions, which in

addition to the physical bene ts can create emotional

bene ts (Yaser & Sadeghi 2012).

In addition, water can also increase the  exibility

of muscles and bones, thereby reducing muscle-bone

spasms and increase the individual’s power.Water exer-

cise also reduces heart rate, cardiac workload and oxy-

gen consumption during exercise on land(Ghaffari et al.,

2008). In this regard, the results of the study by Ernst

et al. (1992) where the impact of hot and cold water

bath in 122 patients with varicose veins was examined,

it was shown that the experimental group compared to

the control group in the variables of muscle contraction,

itching, pain when standing or sitting and sensitivity,

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARATIVE EFFECT OF MICRO NEEDLING AND ITS IMPACT ON TRAINING IN WATER 271

Vahideh Riyahi et al.

Table (2-4). Kolmogorov-Smirnov test results for the variables before and after the

test

Variables GroupAverage and

Standard deviation

The signi cance

level

Improvement

Controlpre-Test3/7±4/2044/0

Post-Test2/6±2/2131/0

ExperimentalPre-Test2/3±1/1954/0

Post-Test5/8±5/1221/0

showed signi cant improvement (Ernst et al., 1992). In

the study by Mancini et al. (2003), the effect of a sulfur

bath with hot water on the quality of life of patients

with varicose veins revealed that the quality of life in

these patients has signi cantly improved (Mancini Jr

et al., 2003).

Given that the risk of varicose veins has become

prevalent among the population, most of these patients

would like to use non-invasive and non-pharmacologi-

cal methods for treatment. Considering that few studies

exist in the  eld of the impact of exercise on varicose,

and so far, the theory of the ef ciency of practice in

water to improve varicose veins is based more on expe-

rience. Moreover, with respect to the role of self-con-

trol and non-pharmacological methods, such as sports

activities, particularly water training, on the quality of

life in patients with varicose, the aim of this study is to

compare the effect of a period of micro needling and the

impact of training in water on the treatment of women

with foot varicose. A 20-week period of microneedling

has no signi cant effect on the treatment of women

with varicose leg. A 20-week period of training in water

usage has no signi cant effect on the treatment of the

women suffering from varicose legs.

MATERIAL AND METHODS

The study population included all women with varicose

veins in the age range between 40 to 60 years who have

gone to health centers for treatment.

The sample consisted of a total of 30 diagnosed

women, of those, 10 patients were randomly divided

into a control group and two groups of 10 people will

be selected as the experimental group.After introducing

the participants about the purpose of the study, in the

 rst step, measuring pain intensity was performed using

questionnaires. After the initial evaluation of samples,

microneedling and training in water were used and con-

ducted for 20 weeks and every four weeks for a total of

5 session meetings under the supervision of an expert. It

should be noted that the research subjects must not have

experienced the microneedling or the training in water,

previously. Moreover, the use of any antidepressant

medications during the study will be prohibited and any

treatment with these drugs should be avoided for at least

7 days before the study begins. This study regarding the

lack of any physical and psychological risks to the sub-

jects was approved by sports medicine and orthopedic

specialists.Subjects who were 30 patients were divided

randomly into three groups equally. Group A: control

group, including subjects who during the 20-week study

did not have any therapeutic intervention. Group B and

C, the experimental group who used microneedling and

training in water for 20 weeks and a session for each 4

weeks and a total of 5 sessions.

In the present study to determine effects of micronee-

dling and the training in water in two stages, mentioned

indicators were measured regarding micro needling and

the training in water: one day before the beginning, and

in the second phase one day after the 20-week period

ends.

The subjects had to answer questions based on a

Likert scale of 5 options. Each subscale separately and

based on visual analog scale VAS were qualitatively

determined.

RESULTS AND DISCUSSION

SURVEYING NORMAL DATA DISTRIBUTION IN

MICRONEEDLING METHOD

To study the normal distribution of data Kolmogorov-

Smirnov test was used. According to this test, distribu-

tion is norma l when the amount is signi cantly higher

than 0/05. The results are provided in table (1-4).

Based on the results of Kolmogorov-Smirnov test,

distribution data for all studied variables were normal.

Therefore, statistical parametric tests were used for data

analysis and hypothesis testing.

A 20-week period microneedling has no signi cant

effect on improvement of women with skin-deep vari-

cose legs.

To check this hypothesis,  rst and foremost, the sta-

tistical paired t-test (paired) were used to compare pre-

test and post-test of each group (Table 2-4) and then

272 COMPARATIVE EFFECT OF MICRO NEEDLING AND ITS IMPACT ON TRAINING IN WATER BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Vahideh Riyahi et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARATIVE EFFECT OF MICRO NEEDLING AND ITS IMPACT ON TRAINING IN WATER 273

t-test was used for comparison of independent groups

(Table 2-4) at the signi cant level of P ≤.0 / 05.

Results showed that the experimental group in post-

test after the exercise protocol in comparison to the pre-

test, show signi cant difference in the pain, and pain

in the experimental group were signi cantly reduced.

But in the control group no signi cant difference was

observed in the degree of pain in the pretest and post-

test. Also according to the results from the table, in com-

paring the change in the groups in post-test, signi cant

difference was observed between the changes. Therefore,

the null hypothesis of no effect of 20 weeks of micro-

needling on the improvement of the women suffering

from skin-deep varicose leg is rejected and it can be

stated that this type of intervention causes improvement

in these individuals.

The results of data analysis within groups showed

that after four weeks of training in the water, varicose

veins improvement in the training group in water in

post-test compared to pre-test was signi cantly differ-

ent (p>0.05). However, in control group, only changes

in improving quality of life were signi cant. In addi-

tion, comparing these variables showed signi cant dif-

ferences in pain intensity and quality of life between the

two groups (p>0.05).

The mean change in pain intensity and quality of life

in the pre-test and post-test in control group and experi-

Table 3-4. paired t-test results of pretest and posttest

VariableGroupPre-TestPost-Test

Within-group

mean difference

Degrees of

freedom

The signi cance

level

Improvement

Control3/7±4/202/6±2/213/1972/1089/0

Experimental2/3±1/195/8±5/124/7911/7001/0

Table 4-4. independent t-test results in post-test

Variable

The mean difference

between groups

Degrees of

freedom

Two-tailed

signi cance level

Improvement3/9192/5001/0

(Table 1) .

Variables Groups Pre and post-test

difference

In-group comparison

t value +P value

Pain intensity Exercise in water 3.150±1.663 7.128 0.000+

(0-5) Control 0.300±0.656

Life quality Exercise in water -20.318±11.064 -6.889 0.000+

(0-100) Control -2.920±2.265

+ is signi cance level at P<0.05 for inter-group changes

FIGURE 1. Comparing the changes in pain in pre-test

and post-test in control and experimental groups.

mental group of exercise in water is also shown in the

diagram (Figure 1, 2).

The results showed that four weeks of training in the

water has a positive impact on reducing pain in women

with varicose veins.

The results of this study are in line with the  nd-

ings of Ernst et al. (1992) showing that exercise pro-

gram results in a signi cant reduction in intensity of

Vahideh Riyahi et al.

274 COMPARATIVE EFFECT OF MICRO NEEDLING AND ITS IMPACT ON TRAINING IN WATER BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

pain(Ernst et al., 1992). Although the method of Ernest

et al. was different from that of ours and they used cold

and hot water method, similar results were obtained;

probably this could represent a desirable therapeutic

property of water. Moreover, the  ndings of the pre-

sent study demonstrate the ef cacy of water exercise

in improving the quality of life in patients with vari-

cose veins, so that comparisons between groups showed

that the average quality of life score between the two

groups was signi cantly different (p<0.05). This  nding

was consistent with the  ndings of Mancini et al. (2003).

In their study, they reported that a period of hot sulfur

water bath could have positive effects on the quality

of life in patients with varicose veins(Mancini Jr et al.,

2003).

As aquatic exercise reduces the pressure load on

joints and provides a suitable environment for activ-

ity of people, it can be very  exible, convenient, and

delightful. Since many studies have shown a positive

relationship between physical activity and mental health

have shown, exercises in water can be a step towards

enhancing the quality of life of people with varicose

veins .

CONCLUSION

Microneedling by stimulating stem cells and  broblasts

in the skin does restorative work in the best possible

way. Given the fact that in skin- deep varicose, the faulty

veins are at the skin surface, 20 weeks use of micronee-

dling stimulates the vascular and skin tissues and reduces

complications of varicose veins and consequently results

in its improvement. The results showed that the use of

microneedling can be a safe and effective treatment in

reducing pain in patients with varicose veins in lower

limbs. The  ndings showed that exercise in water could

improve varicose. Since exercise, especially exercises in

water, can be one of the factors affecting medical condi-

tion, and considering that changes in pain intensity and

life quality scores depend on the type of physical activ-

ity, number of hours and of exercise sessions, intensity

and duration of exercise, doctors and athletic trainers are

suggested that while designing exercises consider special

measures for active recreation programs.

REFERENCES

Carr, S. C. (2006). Current management of varicose veins. Clin-

ical Obstetrics and Gynecology, 49(2), 414–426.

Chung, C. Y., McCray, W. H., Dhaliwal, S., Haywood, T., Black,

M., Liu, J.-B., & Miller, L. S. (2000). Three-dimensional esopha-

geal varix model quanti cation of variceal volume by high-

resolution endoluminal US. Gastrointestinal Endoscopy, 52(1),

87–91.

Diehm, C., & Diehm, N. (2002). Kneipp hydrotherapy, sclero-

therapy, crossectomy. What really helps in varicose veins and

spider veins? MMW Fortschritte Der Medizin, 144(35–36),

22–27.

Ernst, E., Saradeth, T., & Resch, K. L. (1992). Hydrotherapy for

varicose veins: a randomized, controlled trial. Phlebology, 7(4),

154–157.

FIGURE 2. Comparing the changes in quality of life in pre-test and post-test in

control and experimental groups.

Vahideh Riyahi et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARATIVE EFFECT OF MICRO NEEDLING AND ITS IMPACT ON TRAINING IN WATER 275

Ghaffari, S., Ahmadi, F., Nabavi, S. M., Memarian, R., &

Kazemnejad, A. (2008). The effect of progressive muscle relax-

ation technique daily living activities in patients with multiple

sclerosis. J Rehabilitation, 2(30), 73–80.

Gloviczki P, & Yao JST. (2001). Handbook of Venous Disor-

ders: Guidelines of the American Venous Forum. London,

UK:Chapman and Hall Medical.

Goldman, M. P. (2002). Treatment of Varicose and Telangiec-

tatic Leg Veins: Double-Blind Prospective Comparative Trial

Between Aethoxyskerol and Sotradecol. Dermatologic Surgery,

28(1), 52–55.

Harrie, R. P., & Kendall, C. J. (2014). Case Study 137 Orbital

Varix. In Clinical Ophthalmic Echography (pp. 315–315).

Springer. Retrieved from http://link.springer.com/chapter/10.

1007/978-1-4614-7082-3_137

Mancini Jr, S., Piccinetti, A., Nappi, G., Mancini, S., Caniato,

A., & Coccheri, S. (2003). Clinical, functional and quality of life

changes after balneokinesis with sulphurous water in patients

with varicose veins. VASA. Zeitschrift Fur Gefasskrankheiten,

32(1), 26–30.

Stiegmann, G. V., Sun, J. H., & Hammond, W. S. (1988). Results

of experimental endoscopic esophageal varix ligation. The

American Surgeon, 54(2), 105–108.

Van Stiegmann, G., & Goff, J. S. (1988). Endoscopic esophageal

varix ligation: preliminary clinical experience. Gastrointesti-

nal Endoscopy, 34(2), 113–117.

Yaser A, & Sadeghi H. (2012). The effect of a water exercise

program on static and dynamic balance in elder women. Soci

Behavior Sci, 2220–2224.