Trigger Point Needling Workshop. Dr John Apps GP Westport
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1 Trigger Point Needling Workshop Dr John Apps GP Westport
2 Plan V short presentation Look at muscle pain radiation charts Demonstrate on volunteers.
3 Trigger points Areas of damaged muscle that radiate pain. Check trigger point charts for typical patterns. (Travell & Simons) Found by history taking & firm palpation. Ah Shi points. Respond very well to needling, superficial vs deep.
4 Trigger points Minimal additional training needed for doctors. Rapidly treated during standard GP consultation Encourage patients to stretch afterwards Work with physiotherapy or exercise programme if possible. Be aware of red flags & be prepared to change course.
5 Very portable
6 Intramuscular Stimulation Diagnosis & Treatment of myofascial pain conditions. (Chan Gunn) Often have a neuropathic/radicular aspect Concept of shortened muscle causing secondary pain by mechanically stressing muscle attachments: bicipital tendonitis, lateral epicondylitis, disc compression etc Use needle as diagnostic tool.
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11 Intramuscular Stimulation Needling of normal muscle is painless a shortened muscle will grasp the needle with a cramping sensation Often get a muscle twitch Rapid relaxation of tight muscle Treat paraspinal muscles bilaterally.
12 What you need Needles mm Guide tubes are useful Awareness of common trigger point radiation + wall charts Awareness of where NOT to needle Firm palpation technique Couch Cotton wool occasionally.
13 Hazards Bleeding & bruising (check for warfarin therapy). Areas to avoid: Pneumothorax, Organ penetration (pericardium, kidneys) Infection: hepatitis, local infection etc. Broken needles. Forgotten needles. Masking of serious illness.
14 How does it work? Next question please! Chronic Pain with established pain circuit: Fine needle preferentially stimulates certain nerve fibre that sends pain inhibition signals via relays in spinal cord & brain. Acute muscular pain with muscular damage & shortening: fine needle inserted into muscle causes muscle to relax, takes strain off related ligaments, joints, discs, improves microcirculation which dispels accumulated toxins. Placebo/Physician Effect
15 Cases Female 35yrs listed for exploratory laparotomy for right UQ pain: all investigations negative. Hx: pain started during childbirth 3 yrs ago: felt something pop in her back. Trigger point located just lateral to 12 th CV jt on deep palpation.
16 Cases 49yr with worsening sciatic pain: no red flags. 2-3 days complete relief with acupuncture, but then symptoms as bad as before. Pain distribution slowly changing over time + slight prostatism Eventually cauda equina syndrome diagnosed due to sacral schwanomma.
17 Cases 52 yr male with sciatic radiation, dropped AJ. Needing opiates for pain control. Awaiting ortho & MRI 75% symptom improvement with back needling: stopped opiates Update: symptoms now fully resolved.
18 Cases 68 yr female with pain around left hip: xrays normal Clinically: trochanteric bursitis: no response to nsaids Resolved after one treatment: (fencing)
19 Cases 45 yr man with 15yr+ hx of disabling LBP Started after lifting paving slabs in confined space Medication, alcohol & substance dependancy secondary to LBP Multiple paraspinal trigger points treated with great improvement On-going Tx with major change in his attitude to life.
20 Demonstration Trigger points Needles
21 Useful Books Treatment of Chronic Pain: Chan Gunn, Churchill Livingstone: ISBN Acupuncture, Trigger Points & Musculoskeletal Pain: P Baldry, Churchill Livingstone: ISBN Acupuncture Treatment of Pain: Leon Chaitow, Healing Arts Press: ISBN Seirin Atlas of Acupuncture: ISBN A Manual of Acupuncture: Deadman et al: ISBN
22 Web resources British Medical Acupuncture Society NZ Acupuncture Standards Authority
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