TRIGGER POINT DRY NEEDLING

Transcription

1 TRIGGER POINT DRY NEEDLING Sadie Newman PT DPT Cox Health What is it? 1 A skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromuscular pain and movement impairments. How is it different from Acupuncture? 2 Differ in historical, philosophical, indicative, and practical content It is based on western neuroanatomy and modern scientific study of the musculoskeletal and nervous system. Does not use traditional acupuncture theories or terminology. Used by PTs as a modality 1

2 What is a Trigger Point (TrP)? Hyperirritable spots within a taut band of contractured skeletal muscle fibers that produce pain either locally or referred. 1 Active: spontaneously painful 1,2 Latent: Painful when stimulated 1,2 Physiological contractures Local ischemia and hypoxia, lower ph, a chemically altered milieu (active only), altered muscle activation patterns, and referred or local pain 1,3,5 Possible Physiological Theories 1 DN w/rotation Fibroblasts high tension Assumes Lamellar shape Increased Collagen synthesis and cell proliferation. Activated fibroblasts= Release of cytokines and other pro inflammatory mediators= HAPPY MUSCLES! Systemic effect with release of endogenous opioids > Promotes pro inflammatory factors. Mechanotransduction 1 Process by which the body converts mechanical loading into cellular responses. Fibroblast activation with a solid filament has been shown to result in pain neuromodulation 2

3 Types of Dry Needling 1 Deep Inactivates Trigger Points (TrPs) by eliciting local twitch response (LTR) that is modulated by the CNS. Assoc. w/ reduced local and referred pain, improved ROM, decreased TrP irritability both locally and remotely Superficial Activates mechanoreceptors coupled to slow conducting unmyelinated C fiber afferents and indirectly stimulate the anterior cingular cortex. May also be mediated through stimulation of A Delta Fibers or via stretching of fibroblasts in connective tissue. Assoc. w/ reduced local and referred pain Unknown if it has any impact on normalizing the chemical environment or reducing endplate noise assoc. w/trps Indications for Use When Myofascial TrPs are present When there are restrictions in ROM due to contractured muscle fibers, or taut bands, or other soft tissue restrictions (i.e. Fascial adhesions or scar tissues). What can be treated? 1 6 Subscapularis Shoulder Impingement Post CVA Hemiparetic Shoulder Pain Shoulder Impingement with TrPs Chronic RCT (questionable) Neck Pain Scapular retractor pain DeQuervin s Cervical Radiculopathy Patellofemoral Pain Syndrome Knee pain Plantar fascitis TMJ muscular Piriformis Syndrome Plantar heel pain Hip pain Low back pain Lateral and Medial Epicondylitis Plantar Heel Pain And Many Many MORE! 3

4 When is it not recommended? 6 When patient perceives it as threatening (needle phobias) Children younger than 12 y.o. Near damaged skin, thin skin, open wounds, moles, warts, or areas of eczema. Sites with post surgical lymphedema (mastectomy patients should not be needled distal to the site of lymph node removal). Patient with seizure within the last year Precautions 6 Pregnancy Patients with pacemakers receiving electrical dry needling Patients on anticoagulants (INR >3.o should) Patient with seizure (with most recent being >1 year ago). Adverse Reactions 3,6 When performed by a PT was found to have 0.04% adverse reactions as the best reporting and 7% at the worst Pneumothorax (2 cases in 2.2 million sample) and 8.2% adverse events Bruising Bleeding Fainting, Lightheadedness, dizziness, lethargy Reduction in blood sugar levels (caution with diabetics). Recent seizures 4

5 Referrals Referrals must list Trigger Point Dry Needling in physician or provider order for a privileged physical therapist to be able to perform. References 1. (2013, February). Description of Dry Needling In Clinical Practice: An Educational Resource Paper. Retrieved May, 2018, from sourcepaper/ 2. Rise, E. (2015, May). Dry Needling: Getting to the Point. Retrieved May, 2018 from 3. (2016). Copyright Evidence in Motion: Integrated Trigger Point Dry Needling for the Lower Quadrant. 4. Sato, K., Oliveira, A., & Lima, A. (2014). (565) Effectiveness of Dry Needling Reduction Myofascial Trigger Point Pain in the Trapezius Muscle. The Journal of Pain, 15(4). References 5. Calvo Lobo, C., Pacheco Da Costa, S., & Hita Herranz, E. (2017). Efficacy of Deep Dry Needling on Latent Myofascial Trigger Points in Older Adults with Nonspecific Shoulder Pain. Journal of Geriatric Physical Therapy, 40(2), doi: /jpt Continuing Education Course provided by Raymond Butts DPT based on : Copyright of Dry Needling Institute of American Academy of Manipulative Therapy James Dunning, DPT MSc Manip Ther, OCS, MCSP, MAACP (UK), FAAOMPT, MMACP (UK). 5