I am finishing up my last year of graduate school and for one of my courses we have guest speakers from other health professions come and present to our entire athletic training graduate program. This week we had a pleasure of a having a local Physical Therapist(PT) come and present to us on Dry Needling.
Dry Needling is a practice that is growing in popularity in the United States and more and more clinicians are getting trained in it. Athletic Trainers, at least in my state, do not have it in their practice acts to perform dry needling so we must refer out to others that are able to do so. I have referred a patient to this particular PT for dry needling in the past and they had great results from the treatment.
This PT presented on the background of Dry Needling and discussed how it differed from traditional acupuncture (local twitch response on trigger points vs. meridian therapy), and we learned how he incorporated this "modality" into his clinical practice. We also discussed related research to dry needling and it was a pretty informative lecture. Ultimately, he presented the case of undergraduate athletic training student (that is doing a clinical rotation at his clinic)and their chronic injury that coincidentally mirrored that of the patient's that I referred to him. He then went on to utilize dry needling on this student in front of us as part of his lecture, I whipped out my camera to get some video footage of it for all of you!
Before I show you all the footage I will present you with his case:
History:
A 23 y.o. college student has been experiencing R side LBP that began insidiously and has been progressively worsening over the past 2 years. He also reports occasional radicular symptoms to his R posterior thigh area. He rates the intensity of his symptoms between 3/10 - 8/10 that worsen with prolonged sitting in class and while driving. He also notes that he avoids heavy lifting activities at the fitness center including dead lifts and squats. His symptoms are generally decreased with ambulation.
Imaging(who cares, right?):
x-rays were unremarkable, L-Spine MRI revealed moderate disc bulge at L4-L5 level
Self-Report Measures:
Modified Oswestry Disability Questionairre: 14/50 = 28%
Fear Avoidance Belief Questionairre - Work Subscale: = 13
Significant Past Medical History: R ACL reconstructive surgery ('11)
Objective Findings:
ROM:
repeated trunk flexion = no change in sx, repeated extension = pain that increased with repetition, repeated R side gliding = no change in symptoms, repeated L side gliding = no change in symptoms
Sensation:
B LE = intact to light touch and pin prick throughout
MSR:
B patella and B Achilles = 2+
Strength:
R knee ext = 5/5, R knee flex = 5/5, R hip abd = 4-/5, L knee ext = 5/5, L knee flex = 5/5, L hip abd = 4+/5
Mobility:
moderate thoracic spine hypomobility; moderate lumbar spine hypermobility w/ pain provocation
Palpation:
severe R glut max, glut medius, and piriformis hypertonicity w/ pain provocation; elicitation of local twitch response w/ palpation
Assessment: Myofascial Pain Syndrome related to poor strength and stability of lateral hip musculature and core stabilization and hypomobility of the thoracic spine.
Treatment: Dry Needling of the "trigger points" found in the gluteus maximus and gluteus medius. Followed with IASTM of the surrounding musculature and appropriate rehabilitative exercises for strength and stability. There wasn't a true home exercise program recommended to this patient but I would expect that he usually gives them one. I am curious how patients would respond to light IASTM prior to the dry needling instead of doing the opposite.
Here are the two videos! Enjoy! Anyone else have experience with dry needling via patients or personally? I haven't felt it but I am curious to how it feels! I have witnessed it to be an effective treatment but I am still apprehensive about "trigger points" as a topic or entity or our ability to detect them reliably.
This weekend I am off to St. Louis to officially get trained in the Selective Functional Movement Assessment (SFMA) and I am very excited! I was introduced to this by my mentor during my senior internship as an undergraduate and have wanted to take this course since then. If you have read Gray Cook's movement you are probably familiar with the system but if you aren't then the simplest way of describing it is to call it a movement based evaluation system. System and movement are the keywords in that sentence. It is the medical professional evaluative half of the Functional Movement System (brother to the Functional Movement Screen). I will write a course review next week and post it here!
Dry Needling is a practice that is growing in popularity in the United States and more and more clinicians are getting trained in it. Athletic Trainers, at least in my state, do not have it in their practice acts to perform dry needling so we must refer out to others that are able to do so. I have referred a patient to this particular PT for dry needling in the past and they had great results from the treatment.
This PT presented on the background of Dry Needling and discussed how it differed from traditional acupuncture (local twitch response on trigger points vs. meridian therapy), and we learned how he incorporated this "modality" into his clinical practice. We also discussed related research to dry needling and it was a pretty informative lecture. Ultimately, he presented the case of undergraduate athletic training student (that is doing a clinical rotation at his clinic)and their chronic injury that coincidentally mirrored that of the patient's that I referred to him. He then went on to utilize dry needling on this student in front of us as part of his lecture, I whipped out my camera to get some video footage of it for all of you!
Before I show you all the footage I will present you with his case:
History:
A 23 y.o. college student has been experiencing R side LBP that began insidiously and has been progressively worsening over the past 2 years. He also reports occasional radicular symptoms to his R posterior thigh area. He rates the intensity of his symptoms between 3/10 - 8/10 that worsen with prolonged sitting in class and while driving. He also notes that he avoids heavy lifting activities at the fitness center including dead lifts and squats. His symptoms are generally decreased with ambulation.
Imaging(who cares, right?):
x-rays were unremarkable, L-Spine MRI revealed moderate disc bulge at L4-L5 level
Self-Report Measures:
Modified Oswestry Disability Questionairre: 14/50 = 28%
Fear Avoidance Belief Questionairre - Work Subscale: = 13
Significant Past Medical History: R ACL reconstructive surgery ('11)
Objective Findings:
ROM:
repeated trunk flexion = no change in sx, repeated extension = pain that increased with repetition, repeated R side gliding = no change in symptoms, repeated L side gliding = no change in symptoms
Sensation:
B LE = intact to light touch and pin prick throughout
MSR:
B patella and B Achilles = 2+
Strength:
R knee ext = 5/5, R knee flex = 5/5, R hip abd = 4-/5, L knee ext = 5/5, L knee flex = 5/5, L hip abd = 4+/5
Mobility:
moderate thoracic spine hypomobility; moderate lumbar spine hypermobility w/ pain provocation
Palpation:
severe R glut max, glut medius, and piriformis hypertonicity w/ pain provocation; elicitation of local twitch response w/ palpation
Assessment: Myofascial Pain Syndrome related to poor strength and stability of lateral hip musculature and core stabilization and hypomobility of the thoracic spine.
Treatment: Dry Needling of the "trigger points" found in the gluteus maximus and gluteus medius. Followed with IASTM of the surrounding musculature and appropriate rehabilitative exercises for strength and stability. There wasn't a true home exercise program recommended to this patient but I would expect that he usually gives them one. I am curious how patients would respond to light IASTM prior to the dry needling instead of doing the opposite.
Here are the two videos! Enjoy! Anyone else have experience with dry needling via patients or personally? I haven't felt it but I am curious to how it feels! I have witnessed it to be an effective treatment but I am still apprehensive about "trigger points" as a topic or entity or our ability to detect them reliably.
Gluteus Maximus Dry Needling
Gluteus Medius Dry Needling (Really Long Needle!) Shorter Video
This weekend I am off to St. Louis to officially get trained in the Selective Functional Movement Assessment (SFMA) and I am very excited! I was introduced to this by my mentor during my senior internship as an undergraduate and have wanted to take this course since then. If you have read Gray Cook's movement you are probably familiar with the system but if you aren't then the simplest way of describing it is to call it a movement based evaluation system. System and movement are the keywords in that sentence. It is the medical professional evaluative half of the Functional Movement System (brother to the Functional Movement Screen). I will write a course review next week and post it here!
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