1
|
Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment. Musculoskelet Sci Pract 2022; 62:102622. [PMID: 35841842 DOI: 10.1016/j.msksp.2022.102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling. OBJECTIVES To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone. DESIGN Cadaveric study. METHODS Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space. RESULTS Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm). CONCLUSION Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.
Collapse
|
2
|
Sheldon A, Karas S. Adverse events associated with manual therapy of peripheral joints: A scoping review. J Bodyw Mov Ther 2022; 31:159-163. [DOI: 10.1016/j.jbmt.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
|
3
|
Cushman DM, Scholl LV, Ludlow M, Cunningham S, Teramoto M. Accuracy of rib palpation for dry needling of deep periscapular musculature, measured with ultrasound. J Bodyw Mov Ther 2020; 26:7-11. [PMID: 33992299 DOI: 10.1016/j.jbmt.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/07/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Dry needling of the periscapular musculature is a procedure commonly performed by physical therapists. Needling of the deep musculature may be challenging, and use of a thoracic rib as a "backstop" is often applied to prevent inadvertent puncture of the pleura. The aim of this study was to: 1) To examine the accuracy rate of experienced physical therapists in identifying a mid-scapular thoracic rib using palpation, 2) to understand patient characteristics that affect the accuracy rate, and 3) to examine if therapist confidence levels were associated with palpatory accuracy. METHODS Two experienced physical therapists attempted to palpate a thoracic rib in the mid-scapular region of healthy participants (n = 101 subjects, 202 ribs), and self-reported their level of confidence in an accurate palpation. Their accuracy was verified with ultrasonography. RESULTS The two physical therapists were accurate on 73.3% of palpations and did not differ in accuracy (72.0% vs. 75.0%, p = 0.747). The only ultrasonographic or subject characteristic measurement that correlated with improved accuracy was a reduced muscle thickness (p = 0.032). Therapists' self-reported confidence levels did not correlate to actual accuracy (p = 0.153). DISCUSSION Physical therapists should be aware that palpation of a thoracic rib may not be as accurate as it may seem. The greater thickness of muscle in the area reduces the accuracy of accurate palpation. CONCLUSION Dry needling of the periscapular muscles should be done with caution if using a rib as a "blocking" technique.
Collapse
Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
| | | | - Monica Ludlow
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Shellie Cunningham
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
4
|
Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial. J Clin Med 2020; 9:jcm9061665. [PMID: 32492884 PMCID: PMC7355914 DOI: 10.3390/jcm9061665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022] Open
Abstract
Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term in subjects with mechanical neck pain. This was an evaluator-blinded randomized controlled trial. Subjects were recruited through announcements and randomly allocated into DN or PENS groups. Pain intensity, disability, pressure pain threshold (PPT), range of motion (ROM), and side-bending strength were measured. The analyses included mixed-model analyses of variance and pairwise comparisons with Bonferroni correction. The final sample was composed of 44 subjects (22 per group). Both groups showed improvements in pain intensity (ηp2 = 0.62; p < 0.01), disability (ηp2 = 0.74; p < 0.01), PPT (ηp2 = 0.79; p < 0.01), and strength (ηp2 = 0.37; p < 0.01). The PENS group showed greater improvements in disability (mean difference, 3.27; 95% CI, 0.27–6.27) and PPT (mean difference, 0.88–1.35; p < 0.01). Mixed results were obtained for ROM. PENS seems to produce greater improvements in PPT and disability in the short term.
Collapse
|
5
|
Dommerholt J, Hooks T, Chou LW, Finnegan M. A critical overview of the current myofascial pain literature - November 2018. J Bodyw Mov Ther 2018; 23:65-73. [PMID: 30691765 DOI: 10.1016/j.jbmt.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/01/2023]
Abstract
This is the first issue of this review column since the passing of Dr. Leon Chaitow. We would like to take a brief moment to acknowledge how much his mentorship, friendship, and confidence have meant to us. Leon was a force in osteopathic and naturopathic medicine and his influence reaches to all corners of the musculoskeletal realm crossing over many disciplines through his lectures, workshops, and of course, his many books, editorials, and articles. In the foreword to one of his books, Jan Dommerholt wrote that "Leon Chaitow […] continued the work of Travell and Simons, but also of many others, whose contributions he has skillfully woven into an intricate tapestry of clinical pearls, practical tips, and solid evidence-informed research." Dr. Chaitow was a synthesizer, who always considered what different clinicians and researchers could possibly contribute to a better understanding of pain and dysfunction and provide real solutions to real problems. Even when he would not necessarily agree with all suggested remedies, he maintained an open mind and was able to take a step back and consider the bigger picture. For example, Leon was not a big fan of dry needling, yet, he valued the importance of this approach and encouraged the inclusion of dry needling papers in this review article and in his journal. The Journal of Bodywork and Movement Therapies became his baby and, considering the growth of the journal, there is no question that Leon's intense focus and efforts are appreciated by many around the globe. We wish to extend our condolences to Leon's wife Alkmini and daughter Sasha. He will surely be missed, but we can find peace in knowing that his legacy will stay with us forever. In this issue, we have included several basic myofascial pain research articles. As usual, dry needling (DN) studies and case reports are the most commonly referenced papers, but we also included neuroscience and electromyography studies, sleep studies, interrater reliability studies, and case reports of adverse events.
Collapse
Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Todd Hooks
- New Orleans Pelicans, New Orleans, LA, USA; Myopain Seminars, Bethesda, MD, USA.
| | | | - Michelle Finnegan
- Myopain Seminars, Bethesda, MD, USA; ProMove PT Pain Specialists, Bethesda, MD, USA.
| |
Collapse
|
6
|
Uzar T, Turkmen I, Menekse EB, Dirican A, Ekaterina P, Ozkaya S. A case with iatrogenic pneumothorax due to deep dry needling. Radiol Case Rep 2018; 13:1246-1248. [PMID: 30258516 PMCID: PMC6148831 DOI: 10.1016/j.radcr.2018.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022] Open
Abstract
Deep dry needling is an evidence-based treatment technique that is accepted and used by physical therapists for treatment of musculoskeletal pain. We present a case of iatrogenic pneumothorax due to deep dry needling over the posterior thorax. A 36-year old presented with right chest pain 2 hours after dry needling for pain in his back muscles. Chest radiograph suggested small right pneumothorax and the finding was confirmed by computed tomography. Not only should practitioners and their patients be aware of potential complications of dry needling, but also physicians who might see patients with complications.
Collapse
Affiliation(s)
- Tugce Uzar
- Medical Intern, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | - Irem Turkmen
- Medical Intern, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | - Elif Berber Menekse
- Physical Therapy and Rehabilitation, Istinye University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Adem Dirican
- Samsun Medicalpark Hospital, Department of Pulmonary Medicine, Samsun, Turkey
| | - Pankina Ekaterina
- Bashkir State Medical University, Faculty of Medicine, Department of Pulmonary Medicine, Ufa, Russia
| | - Sevket Ozkaya
- Bahcesehir University, Faculty of Medicine, Department of Pulmonary Medicine, Istanbul, Turkey
| |
Collapse
|
7
|
Dhingra D, Singh A, Masood O. Safety Pin as a Chest Tube Clamp - Cause of Iatrogenic Pneumothorax. Indian J Pediatr 2017; 84:879-880. [PMID: 28667500 DOI: 10.1007/s12098-017-2407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Dhulika Dhingra
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, 110031, India.
| | - Amitabh Singh
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, 110031, India
| | - Omar Masood
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi, India
| |
Collapse
|
8
|
Dommerholt J, Chou LW, Finnegan M, Hooks T. A critical overview of the current myofascial pain literature - June 2017. J Bodyw Mov Ther 2017; 21:673-683. [PMID: 28750983 DOI: 10.1016/j.jbmt.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We would like to welcome Dr. Li-Wei Chou, MD, PhD as our newly appointed contributing author. Dr. Chou is Assistant Professor at China Medical University in Taichung, Taiwan and he has an impressive publication record with many research studies and book chapters. The current overview includes several articles comparing dry needling (DN) to acupuncture with sharply contrasting points of view. Several basic studies shed further light on the nature of myofascial pain, myalgia, fascia and examination techniques, such as sonoelastography. Neuroimaging studies demonstrated microstructural abnormalities in brain gray matter of chronic myofascial pain patients, which is an important new finding. As usual, many manual TrP papers and DN papers were published in the past several months.
Collapse
Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | | | - Michelle Finnegan
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Todd Hooks
- Myopain Seminars, Bethesda, MD, USA; New Orleans Pelicans, New Orleans, LA, USA.
| |
Collapse
|
9
|
Kelly ME, Mc Nicholas D, Killen J, Coyne J, Sweeney KJ, McDonnell J. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J 2017; 24:23-27. [DOI: 10.1111/tbj.12831] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/21/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Michael E. Kelly
- Department of Breast Surgery; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| | - Daniel Mc Nicholas
- Department of Breast Surgery; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| | - James Killen
- Department of Breast Surgery; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| | - Joey Coyne
- Department of Anesthesia; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| | - Karl J. Sweeney
- Department of Breast Surgery; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| | - John McDonnell
- Department of Anesthesia; University Hospital Galway; Saolta University Healthcare Group; Galway Ireland
| |
Collapse
|
10
|
Ahiskalioglu EO, Alici HA, Dostbil A, Celik M, Ahiskalioglu A, Aksoy M. Pneumothorax after trigger point injection: A case report and review of literature. J Back Musculoskelet Rehabil 2016; 29:895-897. [PMID: 26922846 DOI: 10.3233/bmr-160666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myofascial pain syndrome is defined as ``pain and/or autonomic phenomena referred from active myofascial trigger points''. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain. Trigger point injection in the cervicothoracic regions can be associated with pneumothorax. CASE In this paper, we presented a patient who developed pneumothorax after trigger point injection. RESULT This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions.
Collapse
Affiliation(s)
- Elif Oral Ahiskalioglu
- Department of Anesthesiology and Reanimation, Regional Training and Research Hospital, Erzurum, Turkey
| | - Haci Ahmet Alici
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
11
|
Fernández-de-Las-Peñas C, Layton M, Dommerholt J. Dry needling for the management of thoracic spine pain. J Man Manip Ther 2015; 23:147-53. [PMID: 26309385 DOI: 10.1179/2042618615y.0000000001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.
Collapse
Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain ; Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain ; Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Michelle Layton
- Myopain Seminars, LLC, Bethesda, MD, USA ; Bethesda Physiocare, Inc, Bethesda, MD, USA
| | - Jan Dommerholt
- Myopain Seminars, LLC, Bethesda, MD, USA ; Bethesda Physiocare, Inc, Bethesda, MD, USA ; Universidad CEU Cardenal Herrera, Valencia, Spain
| |
Collapse
|
12
|
Pecos-Martín D, Montañez-Aguilera FJ, Gallego-Izquierdo T, Urraca-Gesto A, Gómez-Conesa A, Romero-Franco N, Plaza-Manzano G. Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial. Arch Phys Med Rehabil 2015; 96:775-81. [PMID: 25582412 DOI: 10.1016/j.apmr.2014.12.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of dry needling into a myofascial trigger point (MTrP) in the lower trapezius muscle of patients with mechanical idiopathic neck pain. DESIGN A single-center, randomized, double-blinded controlled study. SETTING Patients were recruited from the student population of a local hospital by advertisement in the university clinic from January 2010 to December 2011. PARTICIPANTS Patients (N=72) with unilateral neck pain, neck pain for ≥3 months, and active trigger points in the lower trapezius muscle were randomly assigned to 1 of 2 treatment groups. All the patients completed the study. INTERVENTIONS Dry needling in an MTrP in the lower trapezius muscle, or dry needling in the lower trapezius muscle but not at an MTrP. MAIN OUTCOME MEASURES The visual analog scale (VAS), Neck Pain Questionnaire (NPQ), and pressure-pain threshold (PPT) were assessed before the intervention and 1 week and 1 month postintervention. RESULTS Treatment with dry needling of the lower trapezius muscle close to the MTrP showed decreases in pain and PPT as well as an improvement in the degree of disability (P<.001) compared with the baseline and control group measurements (P<.001). The dry-needling technique performed in the MTrP showed more significant therapeutic effects (P<.001). CONCLUSIONS The application of dry needling into an active MTrP of the lower trapezius muscle induces significant changes in the VAS, NPQ, and PPT levels compared with the application of dry needling in other locations of the same muscle in patients with mechanical neck pain.
Collapse
Affiliation(s)
| | | | | | - Alicia Urraca-Gesto
- Rehabilitation and Physical Therapy Department, University Hospital Alcorcón Foundation, Madrid, Spain
| | - Antonia Gómez-Conesa
- Department of Physical Therapy, Faculty of Medicine, Murcia University, Murcia, Spain
| | | | - Gustavo Plaza-Manzano
- Physical Medicine and Rehabilitation Department, Medical Hydrology, Faculty of Medicine, Complutense University Madrid, Madrid, Spain.
| |
Collapse
|
13
|
McDowell JM, Johnson GM. Acupuncture Needling Styles and Reports of Associated Adverse Reactions to Acupuncture. Med Acupunct 2014. [DOI: 10.1089/acu.2014.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Gillian Margaret Johnson
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
14
|
Coexistence of pneumothorax and Chilaiditi sign: a case report. Asian Pac J Trop Biomed 2014; 4:75-7. [PMID: 24144135 DOI: 10.1016/s2221-1691(14)60212-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/21/2013] [Accepted: 12/20/2013] [Indexed: 11/24/2022] Open
Abstract
We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term "Chilaiditi syndrome" is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.
Collapse
|
15
|
Abstract
In this review we provide the updates on last years' advancements in basic science, imaging methods, efficacy, and safety of dry needling of myofascial trigger points (MTrPs). The latest studies confirmed that dry needling is an effective and safe method for the treatment of MTrPs when provided by adequately trained physicians or physical therapists. Recent basic studies have confirmed that at the site of an active MTrP there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response. Two new modalities, sonoelastography and magnetic resonance elastography, were recently introduced allowing noninvasive imaging of MTrPs. MTrP dry needling, at least partially, involves supraspinal pain control via midbrain periaqueductal gray matter activation. A recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. Therefore, in a patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling.
Collapse
Affiliation(s)
- Simon Vulfsons
- Institute of Pain Medicine, Rambam Health Care Campus and Rappaport School of Medicine, Technion, Spencer Building, 6 Ephron Street, Haifa 31096, Israel.
| | | | | |
Collapse
|
16
|
Acupuncture: moving from mysticism to evidence based practice. PHYSICAL THERAPY REVIEWS 2011. [DOI: 10.1179/174328811x13000948850737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|