Download DRY NEEDLING

DRY NEEDLING A MANUAL THERAPY
STRATEGY FOR THE
INJURED TENNIS
PLAYER
OBJECTIVES ü What is Dry Needling?
ü What is a Triggerpoint?
ü How does a Triggerpoint
develop?
ü What does Dry Needling do?
ü Dry Needling vs Acupuncture
ü Tennis Elbow
ü Shoulder Injuries
ü Hip Injuries
WHAT IS DRY NEEDLING? “Skilled intervention where a thin filament dry needle
penetrates the skin to deactivate myofascial trigger
points to improve connective tissue & joint mobility in
the management of neuromusculoskeletal pain and
movement impairments”
WHAT IS A TRIGGERPOINT? “Trigger points are discrete, focal,
hyperirritable spots located in a taut
band of skeletal muscle that
produce pain locally and in a
referred pattern, cause motor
dysfunction and often accompany
chronic musculoskeletal disorders”.
Alvarez DJ, Rockwell PG & Simons D, Travell J
HOW DO TRIGGERPOINTS DEVELOP? •  Damaged fibers of injured or overloaded
muscles release excessive Acetylcholine at
the neuromuscular junction, causing
spontaneous electrical activity, shortening the
muscle fibers into taut bands.
•  Ongoing depolarization opens cellular
channels allowing calcium to enter
mitochondria.
•  The mitochondria can’t generate ATP to
release the Actin/Myosin to relax the tissue.
•  The tissues become hypoxic,
•  Stimulates the release of nociceptive
chemicals: bradykinin, calcitonin generelated peptide, and substance P, which
activate C-fibers, causing pain.
•  The bradykinin sensitizes the nociceptors via
prostaglandins and also contributes to a
vasodilation-mediated edema.
•  The sensitization and inflammatory response
cause allodynia at the MTRP site and explains
why they are so tender to touch.
Hong CZ & Simons DG,
Kuan TS et al, Ge HY et al.
HOW DO TRIGGERPOINTS DEVELOP? Abnormality of motor end plate or neuromuscular junction
Damaged or overloaded muscle fibers release excessive
Acetylcholine causing spontaneous electrical activity (SEA)
Ongoing depolarization open cellular channels and calcium
enters the mitochondria
The mitochondria can’t generate ATP to release the Actin and
Myosin to relax the tissue.
The tissue becomes hypoxic. Stimulates the release of nociceptive
chemicals: bradykinin, calcitonin gene-related peptide, and
substance P, which activate C-fibers, causing pain.
WHAT DOES DRY NEEDLING DO? •  Deactivates MTRPs
within a muscle
•  Ellicits a LTR
•  Releases
biochemicals
•  Releases shortened
muscles
•  Microtrauma from
needle induces
healing response
•  Decreases pain
•  Restores tissue &
joint mobility
•  “Reset” the muscle
DRY NEEDLING VS ACUPUNCTURE PRECAUTIONS •  Thoracic Spine
•  Lung Fields
•  Viscera
•  Neurovascular Bundles
•  Post Surgical Precautions
CONTRAINDICATIONS •  Inadequate practical
knowledge
•  Consent – denied by patient
•  Compromised equipment sterility
•  Pregnancy
•  Between the ribs
• 
• 
• 
• 
• 
Bleeding disorders
Immunosuppression
Anticoagulants
Local Infection
Over breast implants,
cardiac pacemaker,
spinal stimulators
COMPLICATIONS • 
• 
• 
• 
• 
Needle insertion pain
Vasovagal Reaction
Fainting
Muscle soreness
Fatigue
•  Bruising
•  Pneumothorax
•  Stuck or Broken Needle
(very rare)
REASONS FOR FAILURE •  Diagnostic Error
•  Incomplete management
of other factors
•  Triggerpoint was missed
or inadequately treated
•  Referred zone was treated
•  Inadequate Post Care
•  Level of Experience
TENNIS ELBOW •  Brachioradialis
•  ECRB/L
•  Extensor Digitorum
•  Triceps & Biceps
•  Anconeus
•  Supinator
•  Upper traps, LS
•  Subscapularis
•  Pectorals
•  Teres Minor/IS
•  Lat Dorsi
SHOULDER INJURIES •  Subscapularis
•  Teres Minor/IS
•  Pectorals
•  Deltoid
•  Biceps
•  Upper Traps
•  Levator Scapula
•  Lat Dorsi
•  CT Multifidi
SHOULDER INJURIES
Management of Shoulder Injuries Using
Dry Needling in Elite Volleyball Players.
Osbourne and Gatt. Acupuncture
Med. 2010
•  4 international female volleyball athletes
while in competition
•  Scapulohumeral muscles treated: TM and IS
•  Post Treatment: decreased pain, improved
function, improved ROM in abduction and
IR (pain-free)
•  MMT ER strong and pain-free, negative
empty can
SHOULDER INJURIES
Shoulder Impingement in Tennis/
Racquetball Players Treated with
Subscapularis Myofascial Treatments.
Ingber RS. Arch Phys Med Rehab. 2000
•  3 tennis players diagnosed with shoulder
impingement who did not respond to
conventional treatment
•  MTRPs at the SSC with marked tenderness
•  Shortening, weakness, tenderness to the SSC
•  Dry Needling performed to the SSC
•  Post Treatment: normal, pain-free ROM &
strength, returned to tennis
•  1 and 2-year followup: all still playing tennis
DRY NEEDLING & FUNCTION
Before
After
Retraining
THANK YOU
REFERENCES
•  Shah JP, et al. Biochemicals associated with pain and inflammation are elevated in sites
near to and remote from active myofascial trigger points. Archive Phys Med Rehabil
2008.
•  Shah JP, et al. An invivo microanalytical technique for measuring the local biochemical
milieu of human skeletal muscle. J Appl Physiol 2005.1977-1984.
•  Kong XY et al. Robust upregulation of serotonin 2A receptors after chronic spinal cord
resection in rats: an immunohistochemical study. Brain Res 2010.
•  Kuan TS, Hseih YL, Chen SM, Chen JT, Yen WC, Hong CZ: The myofascial trigger point
region: correlation between the degree of irritability and the prevalence of endplate
noise. Am J Phys Med Rehabil 2007.
•  Ge HY, Fernandez-de-las-Penas C, Yue SW. Myofascial trigger points: spontaneous
electrical activity and its consequences for pain induction and propagation. Chinese
Medicine 2011.
•  Ingber RS. Shoulder Impingement in Tennis/Racquetball Players Treated with
Subscapularis Myofascial Treatments. Arch Phys Med Rehab. 2000
•  Osbourne NJ and Gatt IT. Management of Shoulder Injuries Using Dry Needling in Elite
Volleyball Players. Acupuncture Med. 2010
•  Mayoral Efficacy of myofascial triggerpoint dry needling in prevention of pain after total
knee arthroplasty.
•  Ong J and Claydon LS. The effect of dry for myofascal triggerpoints in neck ad shoulders
Systemic review 2014.
•  Furlan et al. Acupuncture and Dry Needling for low back pain. Cochrane Library. 2011.
•  Lucas KR et al Latent myofascal triggerpoints their effects on muscle activation and
movement efficiency. Body work and movement therapy journal.