TREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING
|
|
- Susanna Eleanor York
- 6 years ago
- Views:
Transcription
1 TREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING Clinical Problem Solving II Allison Walsh
2 PATIENT OVERVIEW Age: 22 years Gender: Female Chief Complaint: Cervical pain, cervicogenic headaches, upper thoracic pain Onset of Symptoms: 2 years ago, insidious onset Pain Level: Ranges from 2/10 to 7-8/10 Aggravating Factors: Turning head, driving, reading Medication: Prescribed anti-inflammatory meds and muscle relaxers Imaging: X-rays unremarkable
3 PATIENT EXAMINATION FINDINGS Posture: Mild thoracic kyphosis, rounded shoulders and forward head in sitting Palpation: Tautness and tenderness to palpation at cervical paraspinals, suboccipitals, scalenes bilaterally, and thoracic paraspinals and upper trapezius on the right Joint Mobility: Hypomobile PA glides C3-C5, T2-T4 and unilateral glides to the right C3-C5 Neck Disability Index: 28/50 (severe disability) Cervical ROM:
4 ASSESSMENT: ICF HEALTH CONDITION: Chronic Mechanical Neck Pain BODY STRUCTURE & FUNCTION: Cervical Pain Decreased Cervical ROM Decreased joint mobility of spine Tautness/TTP cervical and upper thoracic musculature Poor posture ACTIVITY LIMITATIONS: Unable to sit for prolonged periods Difficulty sleeping Difficulty driving Difficulty reading Lifting heavy objects PARTICIPATION RESTRICTIONS: Decreased performance on a student Unable to perform fully as nanny Environmental Factors: On summer break from school, flexible work schedule Personal Factors: Sedentary lifestyle, lack of motivation
5 ASSESSMENT Goals: Short Term (3 weeks): 1. Increased cervical AROM rotation bilaterally to 70 with c/o pain less than 2/10 2. Frequency of headaches no more than 2x/week Long Term (6 weeks): 1. Read for 30 minutes without c/o cervical pain 2. Drive for 30 minutes without c/o cervical pain 3. Frequency of headaches no more than 1x/week Prognosis: Fair-Good Strengths: Age Absence of comorbidities Barriers: Long duration of symptoms Sedentary lifestyle
6 TREATMENT PLAN Patient will be seen 2x week for 6 weeks for the following: Manual Therapy: Deep tissue massage, passive stretching, pressure release Low and high grade PA mobilizations to cervical and thoracic spine High grade unilateral glides at cervical for improved right rotation Gentle passive cervical ROM and contract-relax techniques Therapeutic Exercise: Progression of cervical retractions Cervical ROM and strengthening Scapular retractions/stabilization Patient Education: Postural awareness Book position when reading Lifting techniques
7 PATIENT OUTCOMES After 4 weeks of therapy, patient demonstrated the following: Persistent trigger points Limited cervical AROM Flexion 45, Extension 40 Lateral flexion left 25, right 20 Left rotation 65, right 45 Slight improvement in cervical pain, frequency of headaches, and posture NO GOALS WERE MET Patient states that she has been prescribed dry needling.
8 BACKGROUND: TRIGGER POINT DRY NEEDLING Skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate/inactivate underlying myofascial trigger points by eliciting local twitch responses Alleviation spontaneous electrical activity Reduction of nociceptive, inflammatory, and immune related chemicals Relaxation/decreased irritability of taut band Restored local circulation Reduced local and referred pain Improved range of motion
9 FOR A YOUNG ADULT PATIENT WITH CHRONIC MECHANICAL NECK PAIN, IS TRIGGER POINT DRY NEEDLING MORE EFFECTIVE THAN MANUAL THERAPY IN RELIEVING SYMPTOMS? Clinical Question
10 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL. Llamas-Ramos, R., Pecos-Martín, D., Gallego-Izquierdo, T., Llamas- Ramos, I., Plaza-Manzano, G., Ortega-Santiago, R., & Fernandez-De- Las-Penas, C. (2014). journal of orthopaedic & sports physical therapy, 44(11), Article 1
11 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Design: Randomized clinical trial Level of Evidence: 1b, PEDro - 8/10 Purpose: To compare the short-term effects of trigger point dry needling and trigger point manual therapy in individuals with chronic mechanical neck pain and active trigger points in the upper trapezius muscle. Outcome Measures: Primary: Pain Visual Analog Scale Disability - Northwick Park Neck Pain Questionnaire (NPQ) Secondary: Pressure Pain Threshold - Mechanical Algometer Cervical AROM - CROM device
12 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Methods: Inclusion Criteria: Chronic idiopathic mechanic neck pain Upper trapezius trigger point Exclusion Criteria: Whiplash, previous cervical surgery, cervical radiculopathy or myelopathy, fibromyalgia, PT in the past year, fear of needles, or contraindication to dry needling.
13 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Methods: 2 treatments, 1x/week Intervention Group (DN): Trigger point dry needling of upper trapezius Treating only 1 unilateral trigger point Fast in and fast out technique, no rotation After 1 st twitch response, needle is moved up and down at 1 Hz for seconds Comparison Group (MT): Trigger point manual therapy 1. Pressure Release x 3 2. Stretching of taut band muscle fibers 3. Passive stretch of upper trapezius - 45 seconds 1 2 3
14 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Methods: Assessment Baseline Post-intervention (1 day after 2 nd treatment) Follow-up 1 week post treatment Follow-up 2 weeks post treatment Results: Participants: 94 subjects 47 intervention group (2 lost to followup) 47 comparison group (1 lost to followup) Age: 31 +/- 3 years Gender: 66% female Duration of symptoms: 7 +/- 2.7 months Pain intensity (0-10): 6.2 +/- 1.3 NPQ (0-36): 18 +/- 7 (severe disability) No adverse events reported
15 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Statistically significant differences: p<0.125 Results: Post-intervention, 1 wk follow-up, 2 wk follow-up: Standardized mean difference SMD: Pain Intensity (MCID 2.1) small = 0.2; medium = 0.5; and large = Within groups: Large improvement in both (SMD>2.8) DN /- 0.4 MT /- 0.4 Between groups: No significant difference (p=.516) Neck Disability NPQ (MCID-25% reduction) Within groups: Large improvement in both (SMD>2.8) DN /- 1.5 (72%) MT /- 1.4 (72%) Between groups: No significant difference (p=.411) Cervical AROM (MDC 5-10) Within group: Large improvement in both (SMD>1.4) DN 6.5 +/- 1.7 MT 5.6 +/- 1.5 Between groups: No significant difference (0.139<p<0.917) Pressure Pain Threshold (MDC 47.2) Within group: Large improvement in both: DN / MT / Between groups: Significant difference (p<0.001)
16 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Conclusion: 2 sessions of either trigger point manual therapy or trigger point dry needling were similarly effective for decreasing pain and improving function and cervical range of motion. Statistically significant between group difference for changes in pressure pain threshold in favor of the group that received trigger point dry needling. Impact on function? Precursor?
17 COMPARISON OF THE SHORT-TERM OUTCOMES BETWEEN TRIGGER POINT DRY NEEDLING AND TRIGGER POINT MANUAL THERAPY FOR THE MANAGEMENT OF CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CLINICAL TRIAL (LLAMAS-RAMOS ET AL., 2014) Limitations: Only one trigger point in the upper trapezius was treated, only 2 sessions Only collected data at a short-term follow-up of 2 weeks. Not consistent with typical multimodal approach in PT Not a control group, improvements due to the passage of time? Relevance to Patient: This study would suggest that two sessions of trigger point dry needling would not have provided any more pain relief or cervical range of motion in the short term for my patient than current treatment. More sessions? Long-term effects? Treating ALL trigger points?
18 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL Cerezo-Téllez, E., Torres-Lacomba, M., Fuentes-Gallardo, I., Perez-Muñoz, M., Mayoral-del-Moral, O., Girbes, E. L.,... & Falla, D. (2016).PAIN. Article 2
19 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Design: Randomized clinical trial Level of Evidence: 1b, not yet on PEDro Purpose: To evaluate the effectiveness of deep dry needling in people with chronic nonspecific neck pain attributed to myofascial pain syndrome with active myofascial trigger points in their cervical muscles. Outcome Measures: Primary: Pain Visual Analog Scale Secondary: Pressure Pain Threshold - Mechanical Algometer Cervical AROM - CROM device Cervical Strength - Dynamometer Disability - Neck Disability Index
20 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Methods: Inclusion Criteria: Chronic non-specific (mechanical) neck pain greater than 6 months Myofascial Pain Syndrome Exclusion Criteria: Major trauma, pregnancy, widespread pain, inflammatory/neurological/hormonal/psychiatric disorders, upper extremity tendinopathy, fibromyalgia, certain medication use within one week of the study or contraindication to dry needling
21 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Methods: 4 treatments, 2x/week over 2 weeks Intervention Group (DDN): Deep dry needling Treat every trigger point Fast in and fast out technique Seek 4-5 twitch responses Passive stretching Performed after dry needling Comparison Group: Passive stretching Same for both groups 36 seconds x 4
22 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Methods: Assessments A0 Baseline A1 Day after second treatment A2 Day after all four treatments A3 Follow-up 15 days post treatment A4 Follow-up 30 days post treatment A5 Follow-up 3 months post treatment A6 Follow-up 6 months post treatment Results: Participants: 128 subjects (no loss to follow-up) 64 intervention 64 comparison Age: 50 +/- 16 years Duration of symptoms: At least 6 months (average not stated) Pain intensity (0-10): 5.1 +/- 1.5 NDI: 34/50 ( severe disability) No adverse events Requested subjects seek no external treatment during 6 month time period
23 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Results: Subjective pain intensity: clinically meaningful improvement with DDN only Post-intervention (A2): ± 0.20 in the DDN group ± 0.17 in the control group 6 month follow-up (A6): ± 0.25 in the DDN group and ± 0.25 in the control group Significant between group difference: 2.48 (p< ) VAS Pain Scale MCID 2.1 MDC 1.3
24 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Pressure Pain Threshold (MCID 1.13) Neck Disability Index: (MCID 10) DDN Control Graph shows R trapezius Cervical Active ROM (MDC 10) Control DDN Cervical Strength (MCID 15 N) Graph shows change in cervical rotation AROM Graph shows change in cervical rotation strength
25 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Conclusion: Deep dry needling with passive stretching applied to participants with chronic nonspecific neck pain was associated with better and clinically meaningful results for pain, mechanical hyperalgesia, range of cervical motion, neck muscle strength, and neck disability when compared with passive stretching only in the short-term and at 6-month follow-up. Limitations: Difficulty controlling external interventions; however, none were registered. Differences in technique of passive stretching by 2 different physical therapists. Differences in treatment time between groups (DDN > comparison).
26 EFFECTIVENESS OF DRY NEEDLING FOR CHRONIC NON-SPECIFIC NECK PAIN: A RANDOMIZED, SINGLE BLINDED, CLINICAL TRIAL (CEREZO-TÉLLEZ ET AL., 2016) Relevance to Patient: At least four sessions of dry needling, treating all identifiable trigger points, & seeking 4-5 twitch responses may have a positive effect on my patient s pain, cervical ROM, strength and perceived disability. Could not conclude that dry needling would be more effective than manual therapy, as passive stretching alone is not likely to have as strong of an impact as a comprehensive manual therapy approach.
27 CONCLUSION: IS DRY NEEDLING MORE EFFECTIVE THAN MANUAL THERAPY FOR A YOUNG ADULT PATIENT WITH CHRONIC MECHANICAL NECK Article PAIN? 1 (Llamas- Ramos et Al) Short-term effects likely similar, long-term effects unknown. May need to consider other factors: Certification needed Insurance coverage Prescription from physician Article 2 (Cerezo-Téllez et Al) therapist Dry needling is effective but may not be better than comprehensive manual therapy HOWEVER, minimal progress made with conventional therapy Recommend dry needling as an adjunct to manual therapy and therapeutic exercise Further research with stronger design needed. Cost effective Time efficient Wear & tear on
28 REFERENCES Cerezo-Téllez, E., Torres-Lacomba, M., Fuentes-Gallardo, I., Perez-Muñoz, M., Mayoral-del-Moral, O., Girbes, E. L.,... & Falla, D. (2016). Effectiveness of dry needling for chronic non-specific neck pain: a randomized, single blinded, clinical trial. PAIN. Llamas-Ramos, R., Pecos-Martín, D., Gallego-Izquierdo, T., Llamas-Ramos, I., Plaza-Manzano, G., Ortega-Santiago, R.,... & Fernandez-De-Las-Penas, C. (2014). Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 44(11), epaper.pdf
29 QUESTIONS?
Dry Needling and Manual Therapy for Chronic Neck Pain: A Case Study and Literature Review
University of New Mexico UNM Digital Repository Doctor of Physical Therapy Capstones Health Sciences Center Student Scholarship Spring 4-26-2018 Dry Needling and Manual Therapy for Chronic Neck Pain: A
More informationDry Needling of Myofascial Trigger Points
Dry Needling of Myofascial Trigger Points Policy Number: 2.01.100 Last Review: 3/2018 Origination: 3/1/2016 Next Review: 9/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationDry Needling of Myofascial Trigger Points Corporate Medical Policy
Dry Needling of Myofascial Trigger Points Corporate Medical Policy File Name: Dry Needling of Myofascial Trigger Points File Code: UM.REHAB.09 Origination: 04/2015 Last Review: 09/2018 Next Review: 09/2019
More informationCervical Case Study. M. Benson, A. Felts, S. Kibiloski, J. Mowen, A. Rijhwani
Cervical Case Study M. Benson, A. Felts, S. Kibiloski, J. Mowen, A. Rijhwani Medical Dx 35 y.o. female with myofascial pain No significant radiological findings other than reported flattened cervical spine,
More informationTrigger Point Injections TRIGGER POINT INJECTIONS HS-184. Policy Number: HS-184. Original Effective Date: 7/1/2010
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationThe Utilization of the Clinical Practice Guideline: Neck Pain in
The Utilization of the Clinical Practice Guideline: Neck Pain in Diagnosis and Treatment of a Patient with Neck Pain: A Case Report A case report submitted for the degree of Doctor of Physical Therapy
More informationEFFECT OF MYOFASCIAL TRIGGER POINT PRESSURE RELEASE ON HEADACHE IN CHRONIC MECHANICAL NECK PAIN. Radwa Fayek Hammam Mansour
EFFECT OF MYOFASCIAL TRIGGER POINT PRESSURE RELEASE ON HEADACHE IN CHRONIC MECHANICAL NECK PAIN By Radwa Fayek Hammam Mansour First of all I would like to kneel thanking to ALLAH that enable me to conduct
More informationChiropractic , The Patient Education Institute, Inc. amf10101 Last reviewed: 01/17/2018 1
Chiropractic Introduction Chiropractic is health care that focuses on disorders of the musculoskeletal system and the nervous system, and the way these disorders affect general health. Chiropractic uses
More informationDry needling is a technique in which a fine needle
[ research report ] ERIC GATTIE, PT, DPT 1 JOSHUA A. CLELAND, PT, PhD 2 SUZANNE SNODGRASS, PT, PhD 3 The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists:
More informationPost-op / Pre-op Page (ALREADY DONE)
Post-op / Pre-op Page (ALREADY DONE) We offer individualized treatment plans based on your physician's recommendations, our evaluations, and your feedback. Most post-operative and preoperative rehabilitation
More informationChiropractic Glossary
Chiropractic Glossary Anatomy Articulation: A joint formed where two or more bones in the body meet. Your foot bone, for example, forms an articulation with your leg bone. You call that articulation an
More informationHISTORY AND CHIEF COMPLAINT:
submitted by Keith M. Bartley, D.C. Jasper, IN 07/21/11 presented at Cox Seminar in Nashville, TN, on October 8 9, 2011 HISTORY AND CHIEF COMPLAINT: 01/21/11 55 year old male press operator for Jasper
More informationDynamic Neural Mobilization as an Adjunct Intervention for a Patient with Cervical Radiculopathy: A Case Report.
Dynamic Neural Mobilization as an Adjunct Intervention for a Patient with Cervical Radiculopathy: A. Kara Delie, SPT Kristine Erickson, PT, MS, NCS 1 Abstract: Title: Dynamic Neural Mobilization as an
More informationChiroCredit.com / OnlineCE.com presents Documentation 101 Part 3 of 10 Instructor: Paul Sherman, DC
Online Continuing Education Courses www.onlinece.com www.chirocredit.com ChiroCredit.com / OnlineCE.com presents Documentation 101 Part 3 of 10 Instructor: Paul Sherman, DC Important Notice: This download
More informationConcepts of exercise therapy for neck pain
«Therapeutic Exercise in the workplace - THEWS» Concepts of exercise therapy for neck pain Manos Stefanakis PT, MManipTher, PhD Neck pain Country 1 year incidence Reference UK 30% Palmer et al. 2001, Scand
More informationNeofitos Stefanides, M.D., P.C.
Name: Date: Diagnosis: Date of Surgery: Rotator Cuff Physical Therapy Guidelines and Protocol General Guidelines: - Maintain surgical motion early, but don t push it. - Protect the repair (know what muscles
More informationCase study number - 1, 2 or 3 2 Category - from list of 6 - each case study must be from a different category
! CASE STUDY Student name School Course code Submission date Ian Jenkin London School of Sports Massage LS29B Case study number - 1, 2 or 3 2 Category - from list of 6 - each case study must be from a
More informationS p o r t s & O r t h o p a e d i c S p e c i a l i s t s A n t e r i o r I n s t a b i l i t y P r o t o c o l
S p o r t s & O r t h o p a e d i c S p e c i a l i s t s This protocol provides appropriate guidelines for the rehabilitation of patients with anterior instability. The protocol draws evidence from the
More informationExercise for Reducing Neck Pain and Enhancing Dynamic Stability.
Exercise for Reducing Neck Pain and Enhancing Dynamic Stability www.fisiokinesiterapia.biz Presentation Outline Compare/Contrast Lumbar Exercise Literature to Cervical Spine Discuss Neck Musculature and
More informationLet s get to the point: Therapeutic Dry Needling
Let s get to the point: Therapeutic Dry Needling JILL THEIN-NISSENBAUM, PT, DSC, SCS, ATC ASSOCIATE PROFESSOR, UW-MADISON SMPH STAFF PT, BADGER SPORTSMEDICINE THEIN@PT.WISC.EDU No Conflict of Interest
More informationDocumentation and Billing For Myofacial Disruption Treatment
Documentation and Billing For Myofacial Disruption Treatment Page 1 of 7 Documentation Requirements The following information comes directly from the American Medical Association CPT coding Committee:
More informationAlternative Therapies for Adhesive Capsulitis: A Case Study LANIE ALPHIN
Alternative Therapies for Adhesive Capsulitis: A Case Study LANIE ALPHIN Case Background 53 year old female Chief Complaint: Right shoulder pain for 6 months Diagnosis: Adhesive Capsulitis Imagining indicated
More informationThis Session by Simon Strauss
This Session by Simon Strauss Myofascial Pain. Part A Myofascial Pain. Part B Pain Assessment Tools. Part C Definitions and Language of Pain Allodynia- 1. A lower than normal pain threshold. 2. A clinical
More informationAN EXAMINATION OF OUTCOME MEASURES FOR PAIN AND DYSFUNCTION IN THE CERVICAL SPINE
AN EXAMINATION OF OUTCOME MEASURES FOR PAIN AND DYSFUNCTION IN THE CERVICAL SPINE PICKERING P, OSMOTHERLY P, ATTIA J, MCELDUFF P. SPINE 36(7):581-588 PRESENTED BY: TONY CUMMINGS, ALLY O BRYAN, STEPH SMITH,
More informationOutline. Fascia. Myofascial system. move beyond foam rolling and take your clients with you
Outline move beyond foam rolling and take your clients with you 1. Understanding myofascial restrictions 2. Identifying and correcting postural imbalances 3. Releasing muscle tension with self bodywork
More informationTRIGGER POINT DRY NEEDLING
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,
More informationThe Straw that Broke the Child s Back SPORTS Symposium E. John Stanley PT,SCS
The Straw that Broke the Child s Back 2017 SPORTS Symposium E. John Stanley PT,SCS Learning Objectives: 1.Identify 3 characteristics of kids at risk for back injuries. 2.Describe the impact of flexibility,
More informationNonoperative Treatment For Rotator Cuff Tendinitis/ Partial Thickness Tear Dr. Trueblood
Nonoperative Treatment For Rotator Cuff Tendinitis/ Partial Thickness Tear Dr. Trueblood Relieving Pain Patients who present with SIS will have shoulder pain that is exacerbated with overhead activities.
More informationS p o r t s & O r t h o p a e d i c S p e c i a l i s t s C o n s e r v a t i v e M a s s i v e R o t a t o r C u f f T e a r P r o t o c o l
S p o r t s & O r t h o p a e d i c S p e c i a l i s t s C o n s e r v a t i v e M a s s i v e R o t a t o r C u f f T e a r P r o t o c o l This protocol provides appropriate guidelines for the rehabilitation
More informationReview submitted by Justin Bittner
Azevedo et al. (2016). Pelvic Rotation in Femoroacetabular Impingment Is Decreased Compared to Other Symptomatic Hip Conditions J Orthop Sports Phys Ther, doi:10.2519/jospt.2016.6713 Review submitted by
More informationHeadache & Migraine Survival Guide 4 Steps To Manage Your Pain
Headache & Migraine Survival Guide 4 s To Manage Your Pain Why this Guide? According to the National Institute of Neurological Disorders and Stroke (NINDS) and the American Council for Headache Education
More informationFunctional Dry Needling for the Orthopedic Patient
Functional Dry Needling for the Orthopedic Patient By: Stephanie Brandt PT, DPT CKSPT Bandana Square June 15, 2018 Stephanie Brandt PT, DPT Bachelor s of science in kinesiology from the University of Minnesota
More informationThoracic Spine Management. Jason Zafereo, PT, OCS, FAAOMPT
Thoracic Spine Management Jason Zafereo, PT, OCS, FAAOMPT Clinical i l Orthopedic Rehabilitation ti Education Objectives Describe the treatment interventions used for the management of pain from contractile
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Short Term Effects of Kinesiology Taping on Mechanical Neck Pain Joshi Rasika S 1, Srivastava
More informationThoracic Spine Mobilization for Shoulder Pain. Scott Tauferner PT, ATC
Thoracic Spine Mobilization for Shoulder Pain Scott Tauferner PT, ATC Conflicts of Interest None 1 2 3 Participants will be able to select thoracic mobilization strategies in patients with shoulder pain.
More informationMyofascial Pain Massage Trigger point injection Heat, cold, acupuncture, relaxation training, and biofeedback Treatments. Pain medicines Exercise
Myofascial Pain Myo is a Greek word for muscle. Fascia is the tough outer lining of a muscle that holds it in place. Myofascial pain is the term used to describe pain in the muscles and fascia. Myofascial
More informationJournal of Orthopaedic & Sports Physical Therapy. January 2012; Volume 42; Number 1; pp. 5-18
1 Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial Journal of Orthopaedic & Sports Physical
More informationMs. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS
Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Consultant Orthopaedic Surgeon, Shoulder Specialist. +353 1 5262335 ruthdelaney@sportssurgeryclinic.com Modified from the protocol developed at Boston Shoulder
More informationDynamic Neuromobilization for the Treatment of Thoracic Outlet Syndrome Courtney Convey and Dr. Erickson
Dynamic Neuromobilization for the Treatment of Thoracic Outlet Syndrome Courtney Convey and Dr. Erickson Abstract Title: Dynamic Neuromobilization for the Treatment of Thoracic Outlet Syndrome Background:
More informationPhase I : Immediate Postoperative Phase- Protected Motion. (0-2 Weeks)
Phase I : Immediate Postoperative Phase- Protected Motion (0-2 Weeks) Appointments Progression Criteria 2 weeks after surgery Rehabilitation appointments begin within 7-10 days of surgery, continue 1-2
More informationRegional Review of Musculoskeletal System: Head, Neck, and Cervical Spine Presented by Michael L. Fink, PT, DSc, SCS, OCS Pre- Chapter Case Study
Regional Review of Musculoskeletal System: Presented by Michael L. Fink, PT, DSc, SCS, OCS (20 minutes CEU Time) Subjective A 43-year-old male, reported a sudden onset of left-sided neck and upper extremity
More informationCervical Spine Exercise and Manual Therapy for the Autonomous Practitioner
Cervical Spine Exercise and Manual Therapy for the Autonomous Practitioner Eric Chaconas PT, PhD, DPT, FAAOMPT Assistant Professor and Assistant Program Director Doctor of Physical Therapy Program Eric
More informationEffectiveness of dry needling for chronic nonspecific neck pain: a randomized, singleblinded,
Research Paper Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, singleblinded, clinical trial Ester Cerezo-Téllez a, *, María Torres-Lacomba a, Isabel Fuentes-Gallardo a,b,
More informationManual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain A Randomized, Controlled Trial
Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain A Randomized, Controlled Trial Annals of Internal Medicine,, Vol. 136 No. 10, Pages 713-722 May
More informationHealth & Wellness. The Physical Therapists At Orthopedic Physical Therapy, Inc. Will Guide You To Pain Relief! orthopedicptinc.com
Health & Wellness The Newsletter About Your Health And Caring For Your Body Is It Possible To Live Without Neck Pain & Headaches? Here s What You Need To Do When Your Regular Treatment Plans Don t Work
More informationHistory Prior to Presenting to Us
2013 Part 3 Cox Certification in Maui Case Report Chronic Severe S Scoliosis (Lumbar dextroscoliosis and Thoracic levoscoliosis) treated successfully using Chiropractic for over 30 years and Cox Technic
More informationRotator Cuff Repair Protocol
Rotator Cuff Repair Protocol Applicability: Physician Practices Date Effective: 11/2016 Department: Rehabilitation Services Supersedes: Rotator Cuff Repair (Beattie) Date Last Reviewed / or Date Last Revision:
More informationDeceleration during 'real life' motor vehicle collisions: A sensitive predictor for the risk of sustaining a cervical spine injury?
Deceleration during 'real life' motor vehicle collisions: A sensitive predictor for the risk of sustaining a cervical spine injury? 1 Patient Safety in Surgery March 8, 2009 Martin Elbel, Michael Kramer,
More informationWhy choose Ottauquechee PT
Why does your back hurt? Low back pain is one of the most common patient complaints affecting 80% of adults at some point in their lives. Generally the source of pain is in the spine and/or its supporting
More information1. Introduction. Correspondence should be addressed to Roy La Touche; Received 5 September 2015; Accepted 21 October 2015
Pain Research and Treatment Volume 2015, Article ID 327307, 15 pages http://dx.doi.org/10.1155/2015/327307 Research Article Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with
More informationNeck Pain & the Cervical Spine
Neck Pain & the Cervical Spine At Loudoun Sports Therapy Center, we are specialists in treating all orthopedic conditions and injuries. It s our goal to help you live a healthy, active, pain-free lifestyle.
More informationEffectiveness Of Manual Physical Therapy For Painful Shoulder Conditions A Systematic Review
Effectiveness Of Manual Physical Therapy For Painful Shoulder Conditions A Systematic Review Keeping Manual Physical Therapy In Effectiveness Manual Therapy of manual physical therapy for painful shoulder
More informationBradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone
Rehabilitation following Arthroscopic Rotator Cuff Repair: Medium Tears Phase I: Immediate Postsurgical Phase (Days 10-14) Precautions: No lifting of objects; No excessive arm motions; No excessive external
More informationMyofascial Pain Syndrome and Trigger Points. Paul S. Sullivan, Do Trinity Health Care New England - Family Medicine
Myofascial Pain Syndrome and Trigger Points Paul S. Sullivan, Do Trinity Health Care New England - Family Medicine Objectives Discuss why this topic is pertinent to our practices Review diagnostic criteria
More informationAn Introduction to Foam Rolling, Part 1 by Jeremy Bushong, MS, CSCS
An Introduction to Foam Rolling, Part 1 by Jeremy Bushong, MS, CSCS Foam rolling has recently become popular in the realms of athletic training, strength and conditioning, and fitness enthusiasts as a
More informationEFFECTIVENESS OF CONVENTIONAL EXERCISE REGIMEN FOR THE TREATMENT OF SHOULDER PAIN
EFFECTIVENESS OF CONVENTIONAL EXERCISE REGIMEN FOR THE TREATMENT OF SHOULDER PAIN Dr.U.Ganapathy Sankar, Ph.D., Dean I/C,Faculty of Medical & Health Sciences, SRM College of Occupational Therapy, SRM University,Kattankulathur,
More informationUpper Cross Syndrome: Assessment & Management in Family Practice HKDU Symposium Dec 2014
Upper Cross Syndrome: Assessment & Management in Family Practice HKDU Symposium Dec 2014 Dr. Ngai Ho Yin Allen Family Medicine Specialist PGDipMusculoskeletal Medicine MBBS(HK), DCH(London), DFM(CUHK),
More informationLatissimus dorsi tendon transfer protocol
Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the physical therapist with a guideline/treatment protocol for the postoperative rehabilitation management
More informationREHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE I TEARS (+/- SUBACROMINAL DECOMPRESSION)
REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE I TEARS (+/- SUBACROMINAL DECOMPRESSION) The rehabilitation guidelines are presented in a criterion based progression. General time frames are
More informationArthroscopic Shoulder Surgery /Meniscectomy Recovery
Arthroscopic Shoulder Surgery /Meniscectomy Recovery Arthroscopic Shoulder Surgery (Acromioplasty) Recovery Arthroscopic subacromial decompression (ASAD) is a surgical procedure with the goal of relieving
More information1. Stretching and Restoring the Range of Motion in the Cervical Spine 2. Exercises to Strengthen the Neck
1. Stretching and Restoring the Range of Motion in the Cervical Spine 2. Exercises to Strengthen the Neck 1) Stretching and Increasing Mobility Below you will find stretching exercises specifically for
More informationShoulder Impingement Rehabilitation Recommendations
Shoulder Impingement Rehabilitation Recommendations The following protocol can be utilized for conservative care of shoulder impingement as well as post- operative subacromial decompression (SAD) surgery.
More informationWhiplash! The 3 Phases of Healing Introduction-Full recovery from a whiplash injury requires chiropractic care. and the insurance you already have
Whiplash! The 3 Phases of Healing Introduction-Full recovery from a whiplash injury requires chiropractic care. and the insurance you already have will most likely cover chiropractic treatment for a whiplash
More informationMini Open Rotator Cuff Repair Small Tears < 1 cm
Mini Open Rotator Cuff Repair Small Tears < 1 cm **It is the treating therapist s responsibility along with the referring physician s guidance to determine the actual progression of the patient within
More informationEFFECIVENESS OF THE WILLIAMS EXCERCISE IN MECHANICAL LOW BACK PAIN
EFFECIVENESS OF THE WILLIAMS EXCERCISE IN MECHANICAL LOW BACK PAIN Dr.U.Ganapathy Sankar, Ph.D Dean I/C, SRM College of Occupational Therapy, SRMUniversity, Kattankulathur, KancheepuramDistrict, Tamil
More informationManual Therapy Techniques
Manual Therapy Techniques manual therapy: the use of hands-on techniques to evaluate, treat, and improve the status of neuromusculoskeletal conditions massage: the systematic and scientific manipulation
More informationPathology Newton s First Law of Motion states that an object at rest will have a tendency to stay at rest unless acted upon by an outside force.
Whiplash Syndrome Pathology Newton s First Law of Motion states that an object at rest will have a tendency to stay at rest unless acted upon by an outside force. If you are waiting at a red traffic light
More informationBiceps Tenotomy Protocol
Biceps Tenotomy Protocol A biceps tenotomy procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum. A biceps tenotomy is typically done when there is
More informationExercise for Neck Pain
Exercise for Neck Pain Deborah Falla @Deb_Falla Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise and Rehabilitation Sciences College of Life and Environmental Sciences University
More informationRehabilitation Protocol: Massive Rotator Cuff Tear Repair
Rehabilitation Protocol: Massive Rotator Cuff Tear Repair Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington 781-372-7020 Lahey
More informationRN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT ***
HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age - Certain conditions are more prevalent in particular age groups (i.e. Full rotator cuff tears are more common over the age of 45, traumatic injuries
More informationDPT 772 Spine Notebook Matt Kubalski, SPT
DPT 772 Spine Notebook Matt Kubalski, SPT Table of Contents: IMPAIRMENTS/CLASSIFICATIONS PAGES Neck Pain with Mobility Deficit: Cervicalgia, Pain in thoracic spine - JOSPT 3-6 Neck Pain with Headache:
More informationCERVICAL STRAIN AND SPRAIN (Whiplash)
CERVICAL STRAIN AND SPRAIN (Whiplash) Description time and using proper technique decrease the frequency of Whiplash is an injury to the neck caused when it is forcefully whipped or forced backward or
More informationArthroscopic Rotator Cuff Repair Protocol:
Arthroscopic Rotator Cuff Repair Protocol: The intent of this protocol is to provide the therapist and patient with guidelines for the post-operative rehabilitation course after arthroscopic SLAP repair.
More informationNeck Class. Kaiser Permanente Fremont Physical Therapy
Kaiser Permanente Fremont How Body Reacts to Injury and Pain Postural Muscles (Core) become Weak. Deep Neck Muscles Shoulder Blade Muscles Movement Muscles become Tight. Long Neck Muscles Sub-occipital
More informationFacet Joint Syndrome / Arthritis
Facet Joint Syndrome / Arthritis Overview Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to
More informationThe SUPPORT Trial: SUbacromial impingement syndrome and Pain: a randomised controlled trial Of exercise and injection
The SUPPORT Trial: SUbacromial impingement syndrome and Pain: a randomised controlled trial Of exercise and injection SUPPORT Physiotherapy Intervention Training Manual Authors: Sue Jackson (SJ) Julie
More informationUnit 3 -- Relieve the Burden of Shoulder Dysfunction. Upper Torso & Shoulder Unit Study Guide
Unit 3 -- Relieve the Burden of Shoulder Dysfunction Upper Torso & Shoulder Unit Study Guide This unit identifies problems of the shoulder joint and thoracic regions. Module 1 Module 2 Module 3 Module
More informationHOW TO CITE THIS ARTICLE:
TO COMPARE THE EFFECTIVENESS OF MYOFASCIAL RELEASE TECHNIQUE VERSUS POSITIONAL RELEASE TECHNIQUE WITH LASER IN PATIENTS WITH UNILATERAL TRAPEZITIS Ravish V. N 1, Shridhar 2, Sneha Helen 3 HOW TO CITE THIS
More informationCharlotte Shoulder Institute
Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Novant Health Perry & Cook Orthopedics and Sports Medicine 2826 Randolph Rd. Charlotte, NC 28211
More informationJennifer L. Cook, MD Stephen A. Hanff, MD. Rotator Cuff Type I Repair (Small Large Tear)
Jennifer L. Cook, MD Stephen A. Hanff, MD Florida Joint Care Institute 2165 Little Road, Trinity, Florida 34655 PH: (727) 372 6637 FAX: (727) 375 5044 Rotator Cuff Type I Repair (Small Large Tear) This
More informationImproving Thoracic Mobility
Improving Thoracic Mobility By William J. Hanney DPT, PhD, ATC, CSCS Course Description A lack of thoracic mobility can have broad clinical implications and evidence suggests addressing mobility in this
More informationShoulder Arthroscopy: Postop Instructions. Activites & Advice for in the Hospital and while at Home
Dr. Mark Price MGH Sports Medicine Center 175 Cambridge Street, 4th floor Boston, MA 02114 www.massgeneral.org/ortho-sports-medicine/dr-price Shoulder Arthroscopy: Postop Instructions You will wake up
More informationPemotional response to actual or COMPARISON OF SUSTAINED PRESSURE VS ISCHEMIC COMPRESSION ON TRIGGER POINTS IN CHRONIC MYOFACIAL PAIN MANAGEMENT
ORIGINAL ARTICLE COMPARISON OF SUSTAINED PRESSURE VS ISCHEMIC COMPRESSION ON TRIGGER POINTS IN CHRONIC MYOFACIAL PAIN MANAGEMENT ABSTRACT OBJECTIVE: To determine the effect of different trigger points
More informationCHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013
CHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013 Chiropractic Chiropractic focuses on disorders of the musculoskeletal system and the nervous system, and the effects
More informationInternational Journal of Medicine & Health Research
Year: 2014; Volume: 1; Issue: 1 Article ID: MD14 27; Pages: 1-7 International Journal of Medicine & Health Research Research Article Efficacy of intramuscular electrical stimulation with dry needle over
More informationOSTEOPATHIC MASSAGE: COMBINING MASSAGE THERAPY AND OSTEOPATHY IN A TREATMENT. By Angele Boyle
OSTEOPATHIC MASSAGE: COMBINING MASSAGE THERAPY AND OSTEOPATHY IN A TREATMENT By Angele Boyle Since the beginning of March 2011, I have had the opportunity while attending the National Academy of Osteopathy,
More informationPlanning the Objective Exam. Objective Examination of the Cervical Spine. Clearing Tests. Observation. Functional Demonstration.
Objective Examination of the Cervical Spine Taking the complaint and identifying the damaged structure Planning the Objective Exam With a clear picture from the subjective exam, the objective exam should
More informationRotator Cuff Repair Protocol
Rotator Cuff Repair Protocol Applicability: Physician Practices Date Effective: 11/2016 Department: Rehabilitation Services Supersedes: Rotator Cuff Repair (Beattie) Date Last Reviewed / or Date Last Revision:
More informationBiceps Tenodesis Protocol
Biceps Tenodesis Protocol A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical
More informationCharlotte Shoulder Institute
Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Novant Health Perry & Cook Orthopedics and Sports Medicine 2826 Randolph Rd. Charlotte, NC 28211
More informationTHERMAL - ASSISTED CAPSULORRAPHY With or without SLAP Repair
THERMAL - ASSISTED CAPSULORRAPHY With or without SLAP Repair **It is important for the clinician to determine the capsular response to the heat probe. Patients that have excessive ROM early in the rehab
More informationCERVICAL SPINE TIPS A
CERVICAL SPINE TIPS A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of
More informationSUMMARY OF MEDICAL TREATMENT GUIDELINE FOR CARPAL TUNNEL SYNDROME AS IT RELATES TO PHYSICAL THERAPY
SUMMARY OF MEDICAL TREATMENT GUIDELINE FOR CARPAL TUNNEL SYNDROME AS IT RELATES TO PHYSICAL THERAPY Effective March 1, 2013, the New York State Workers Compensation System will implement Medical Treatment
More informationTALLGRASS ORTHOPEDIC & SPORTS MEDICINE. Phase I Immediate Post-Surgical Phase (Weeks 0-2) Date: Maintain/protect integrity of the repair
TALLGRASS ORTHOPEDIC & SPORTS MEDICINE Name: Date of Surgery: Patient Flow Sheet Arthroscopic Rotator Cuff Repair Small to Medium Tears Benedict Figuerres, MD Phase I Immediate Post-Surgical Phase (Weeks
More informationSuprascapular Nerve Entrapment
Suprascapular Nerve Entrapment Suprascapular nerve entrapment is an uncommon nerve condition in the shoulder, causing pain and weakness. It involves compression of the suprascapular nerve at the top or
More informationREHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE II TEARS (MASSIVE)(+/- SUBACROMIAL DECOMPRESSION)
REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE II TEARS (MASSIVE)(+/- SUBACROMIAL DECOMPRESSION) The rehabilitation guidelines are presented in a criterion based progression. General time frames
More informationmain/1103_new 01/11/06
Search date May 2006 Allan Binder QUESTIONS What are the effects of treatments for people with uncomplicated neck pain without severe neurological deficit?...3 What are the effects of treatments for acute
More informationDry Needling: Interventions and Clinical Application
Dry Needling: Interventions and Clinical Application Craig A. Voll, Jr. PhD, ATC, PT Jessica Gillespie, PT, DPT Lafayette Area Sports Symposium February 7, 2018 Objectives: Define Dry Needling (DN) Utilization
More informationDry needling as one of the methods of eliminating myofascial trigger points
Dąbrowska Maria, Lisiecki Jakub, Biernacki Maciej, Grzonkowska Magdalena, Ulenberg Agata, Ulenberg Grzegorz. Dry needling as one of the methods of eliminating myofascial trigger points. Journal of Education,
More information