Upload
amable
View
173
Download
4
Embed Size (px)
DESCRIPTION
Nichole Bluemle PT, DPT, MS, CSCS, OCS. Introduction trigger point dry needling. Objectives. Define Dry Needling Define Trigger Point Causes of Trigger Points Goals of Dry Needling Mechanism of Dry Needling Contraindications Risks/Complications/Adverse Reactions Technique - PowerPoint PPT Presentation
Citation preview
INTRODUCTIONTRIGGER POINT DRY NEEDLING
Nichole Bluemle PT, DPT, MS, CSCS, OCS
Objectives
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 overviewhttp://www.youtube.com/watch?v=1bst-eDCjwg
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
Myofascial Trigger Point “Hyperirritable spots in
skeletal muscle associated with hypersensitive palpable nodules in a taught band.” (Travell and Simons 1992)
Characteristics of Myofascial Trigger Points 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 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 Illicit a local twitch response (LTR) in
involved muscle
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
Mechanical Effects(Dommerholt J. 2004)
Disrupts the integrity of dysfunctional motor end plates
Cause a LTR
Alter muscle fiber length
Neurophysiological Effects(Baldry PE. 2001)
Suggests that dry needling stimulates A-delta nerve fibers (type III) for 72 hours post-needlingProlonged 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)
Decrease in chemicals at the active trigger point location immediately after a local twitch responseBradykininCGRP (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
Risks/Adverse Reactions Pneumothorax Vasovagal reaction Muscle soreness Fatigue Bruising Pain during insertion Infection
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
Needle Technique 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-treatmentRe-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
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
Summary Dry needling performed by a trained
clinician (PT, DO, DC, L.Ac) can relieve myofascial pain caused by trigger points commonly involved in orthopedic conditionsRelease shortened musclesReduce spontaneous electrical activity at the
neuromuscular junctionReturn biochemicals that cause
hypersensitization to normal levelsPromote self healing
Recommended Resources
Questions?Contact Info:
Nichole Bluemle PT, DPT, MS, CSCS, [email protected]