DRY NEEDLING A MANUAL THERAPY STRATEGY FOR THE INJURED TENNIS PLAYER

Transcription

1 DRY NEEDLING A MANUAL THERAPY STRATEGY FOR THE INJURED TENNIS PLAYER

2 OBJECTIVES ü What is Dry Needling? ü What is a Triggerpoint? ü How does a Triggerpoint develop? ü What does Dry Needling do? ü Dry Needling vs Acupuncture ü Tennis Elbow ü Shoulder Injuries ü Hip Injuries

3 WHAT IS DRY NEEDLING? Skilled intervention where a thin filament dry needle penetrates the skin to deactivate myofascial trigger points to improve connective tissue & joint mobility in the management of neuromusculoskeletal pain and movement impairments

4 WHAT IS A TRIGGERPOINT? Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle that produce pain locally and in a referred pattern, cause motor dysfunction and often accompany chronic musculoskeletal disorders. Alvarez DJ, Rockwell PG & Simons D, Travell J

5 HOW DO TRIGGERPOINTS DEVELOP? Damaged fibers of injured or overloaded muscles release excessive Acetylcholine at the neuromuscular junction, causing spontaneous electrical activity, shortening the muscle fibers into taut bands. Ongoing depolarization opens cellular channels allowing calcium to enter mitochondria. The mitochondria can t generate ATP to release the Actin/Myosin to relax the tissue. The tissues become hypoxic, Stimulates the release of nociceptive chemicals: bradykinin, calcitonin generelated peptide, and substance P, which activate C-fibers, causing pain. The bradykinin sensitizes the nociceptors via prostaglandins and also contributes to a vasodilation-mediated edema. The sensitization and inflammatory response cause allodynia at the MTRP site and explains why they are so tender to touch. Hong CZ & Simons DG, Kuan TS et al, Ge HY et al.

6 HOW DO TRIGGERPOINTS DEVELOP? Abnormality of motor end plate or neuromuscular junction Damaged or overloaded muscle fibers release excessive Acetylcholine causing spontaneous electrical activity (SEA) Ongoing depolarization open cellular channels and calcium enters the mitochondria The mitochondria can t generate ATP to release the Actin and Myosin to relax the tissue. The tissue becomes hypoxic. Stimulates the release of nociceptive chemicals: bradykinin, calcitonin gene-related peptide, and substance P, which activate C-fibers, causing pain.

7 WHAT DOES DRY NEEDLING DO? Deactivates MTRPs within a muscle Ellicits a LTR Releases biochemicals Releases shortened muscles Microtrauma from needle induces healing response Decreases pain Restores tissue & joint mobility Reset the muscle

8 DRY NEEDLING VS ACUPUNCTURE

9 PRECAUTIONS Thoracic Spine Lung Fields Viscera Neurovascular Bundles Post Surgical Precautions

10 CONTRAINDICATIONS Inadequate practical knowledge Consent denied by patient Compromised equipment sterility Pregnancy Between the ribs Bleeding disorders Immunosuppression Anticoagulants Local Infection Over breast implants, cardiac pacemaker, spinal stimulators

11 COMPLICATIONS Needle insertion pain Vasovagal Reaction Fainting Muscle soreness Fatigue Bruising Pneumothorax Stuck or Broken Needle (very rare)

12 REASONS FOR FAILURE Diagnostic Error Incomplete management of other factors Triggerpoint was missed or inadequately treated Referred zone was treated Inadequate Post Care Level of Experience

13 TENNIS ELBOW Brachioradialis ECRB/L Extensor Digitorum Triceps & Biceps Anconeus Supinator Upper traps, LS Subscapularis Pectorals Teres Minor/IS Lat Dorsi

14 SHOULDER INJURIES Subscapularis Teres Minor/IS Pectorals Deltoid Biceps Upper Traps Levator Scapula Lat Dorsi CT Multifidi

15 SHOULDER INJURIES Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players. Osbourne and Gatt. Acupuncture Med international female volleyball athletes while in competition Scapulohumeral muscles treated: TM and IS Post Treatment: decreased pain, improved function, improved ROM in abduction and IR (pain-free) MMT ER strong and pain-free, negative empty can

16 SHOULDER INJURIES Shoulder Impingement in Tennis/ Racquetball Players Treated with Subscapularis Myofascial Treatments. Ingber RS. Arch Phys Med Rehab tennis players diagnosed with shoulder impingement who did not respond to conventional treatment MTRPs at the SSC with marked tenderness Shortening, weakness, tenderness to the SSC Dry Needling performed to the SSC Post Treatment: normal, pain-free ROM & strength, returned to tennis 1 and 2-year followup: all still playing tennis

17 DRY NEEDLING & FUNCTION Before After Retraining

18 THANK YOU

19 REFERENCES Shah JP, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archive Phys Med Rehabil Shah JP, et al. An invivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol Kong XY et al. Robust upregulation of serotonin 2A receptors after chronic spinal cord resection in rats: an immunohistochemical study. Brain Res Kuan TS, Hseih YL, Chen SM, Chen JT, Yen WC, Hong CZ: The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil Ge HY, Fernandez-de-las-Penas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chinese Medicine Ingber RS. Shoulder Impingement in Tennis/Racquetball Players Treated with Subscapularis Myofascial Treatments. Arch Phys Med Rehab Osbourne NJ and Gatt IT. Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players. Acupuncture Med Mayoral Efficacy of myofascial triggerpoint dry needling in prevention of pain after total knee arthroplasty. Ong J and Claydon LS. The effect of dry for myofascal triggerpoints in neck ad shoulders Systemic review Furlan et al. Acupuncture and Dry Needling for low back pain. Cochrane Library Lucas KR et al Latent myofascal triggerpoints their effects on muscle activation and movement efficiency. Body work and movement therapy journal.