Transcript Introduction trigger point dry needling

Nichole Bluemle PT, DPT, MS, CSCS, OCS
Objectives
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Define Dry Needling
Define Trigger Point
Causes of Trigger Points
Goals of Dry Needling
Mechanism of Dry Needling
Contraindications
Risks/Complications/Adverse Reactions
Technique
Post Treatment
Reasons for failure
APTA Stance
NM PT State board
Summary
Recommended Resources
Video overview
http://www.youtube.com/watch?v=1bsteDCjwg
Trigger Point Dry Needling
TDN, Functional Dry Needling (FDN),
Intramuscular Stimulation (IMS),
Intramuscular Manual Therapy (IMT)
 Invasive procedure where a monofilament
needle is inserted into a trigger point
 Called dry needling because it does not
involve injection of a “wet” substance like
trigger point injections
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Myofascial Trigger Point
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“Hyperirritable spots in
skeletal muscle
associated with
hypersensitive palpable
nodules in a taught
band.” (Travell and Simons 1992)
Characteristics of Myofascial
Trigger Points
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Localized tenderness upon palpation of a
taut band of muscle
LTR to cross-fiber stimulation of a taut
band
Pain to deep palpation that is recognized
pain
Referred pain to a characteristic region
based on myofascial referral maps
Autonomic phenomena (sweating,
piloerction, vasomotor)
Referral Maps
Causes of Trigger Points
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Repetitive movements/low level muscle
contractions
Compressive forces
Trauma (contusion/strain)
Unaccustomed eccentric contractions/
eccentric contractions in untrained muscles
(DOMS)
Emotional stress
Postural stress
Dehydration
Goal of Dry Needling
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Illicit a local twitch response (LTR) in
involved muscle
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Desensitize hypersensitive
musculoskeletal structures while
restoring motion and function
Mechanisms of Dry Needling
Releasing shortened muscles
Removing irritation of spinal nerve roots by
relieving short paraspinal muscles
 Promote healing through local inflammation
response (increased blood flow to include
platelet derived growth factor)
 Decrease spontaneous electrical activity
and biochemicals in myofascial trigger
points
 Decrease pain associated with myofascial
trigger points
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Mechanical Effects
(Dommerholt J. 2004)
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Disrupts the integrity of dysfunctional
motor end plates
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Cause a LTR
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Alter muscle fiber length
Neurophysiological Effects
(Baldry PE. 2001)
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Suggests that dry needling stimulates Adelta nerve fibers (type III) for 72 hours
post-needling
 Prolonged stimulation of A-delta fibers may
activate enkephalinergic inhibitory dorsal
interneurons
 Activate descending inhibitory systems
which would block noxious stimulus into the
dorsal horn
Chemical Effects
(Shah J. et al. 2005)
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Decrease in chemicals at the active
trigger point location immediately after a
local twitch response
 Bradykinin
 CGRP (calcitonin gene related peptide)
 Substance P
Contraindications
Denial of consent
 High level patient fear/apprehension
 Bleeding disorders or on anti-coagulants
 Pregnancy
 Directly over joint replacement/breast
implant/pacemaker
 Infection/illness
 Unstable bone injury
 Malignant tumor
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Risks/Adverse Reactions
Pneumothorax
 Vasovagal reaction
 Muscle soreness
 Fatigue
 Bruising
 Pain during insertion
 Infection
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 Always a possibility but reduced likelihood
by adhering to sterile guidelines
Minimize Infection Risk
Always wash hands between patients
 Treatment area well lit and clear of
clutter
 Sterile, one time use individually
packaged needles
 Clean treatment field (alcohol pad)
 Sharps container closed between
patients
 Single use firm fitting gloves
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Needle Technique
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Identify anatomical landmarks, taut band,
and the trigger point
Clean the area with alcohol pad
Place the needle over the trigger point and
tap into skin at a 90deg angle (angle may
need to be altered based on anatomy)
Advance the needle into the trigger point
Piston (redirect the needle, pull the needle
up to the subcutaneous layer, redirect,
again advance into muscle)
Remove needle and apply direct pressure
Post-treatment
Re-evaluate
 Stretch/PROM/AROM
 Instruct patient in self mobilization
techniques
 Heat
 Movement facilitation tape
 Hydration
Reasons for Failure
Diagnostic error
 Incomplete management of perpetuating
factors
 Trigger point missed or inadequately
treated
 Referred zone treated
 Inadequate post care
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Scope of Practice
Determined by individual state board if in scope
of practice and if/what training requirements
must be met
 Many states determine dry needling to be in the
scope of practice for Physical Therapists,
Acupuncturists, Chiropractors
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Summary
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Dry needling performed by a trained
clinician (PT, DO, DC, L.Ac) can relieve
myofascial pain caused by trigger points
commonly involved in orthopedic
conditions
 Release shortened muscles
 Reduce spontaneous electrical activity at the
neuromuscular junction
 Return biochemicals that cause
hypersensitization to normal levels
 Promote self healing
Recommended Resources
Questions?
Contact Info:
Nichole Bluemle PT, DPT, MS, CSCS, OCS
www.durangophysicaltherapy.com
[email protected]