Download Common Conditions That Respond Well To Manual Therapy

Common Conditions That Respond Well To Manual Therapy
TMJ is a common jaw dysfunction
involving pain, clicking and locking in
the mandibular (jaw) joint. Tightness
of the muscles surrounding the jaw can
cause an imbalance which leads to TMJ.
Trigger point release of these muscles
is pivotal for complete recovery from
this condition.
Shoulder, Elbow, and Wrist Pain
Low Back And Neck Pain
Muscle strains are the most common
cause of low back & neck pain. The
good news is that most muscle strains
usually resolve completely within a
few weeks. Sometimes they don’t
completely resolve, and, especially as
we age, may lead to soft tissue changes
that can be treated with manual
therapy.
Sciatica is a well-known condition
involving pain that extends from the hip
into the back of the leg. Most people
don’t realize that this pain can actually
be caused by trigger points in the
gluteal muscles and manual therapy
can treat this condition quite easily.
Whiplash pain is primarily due to
trigger points in the muscles of the
neck. Release of key trigger points in
this region can give rapid, lasting relief.
Head & Jaw Conditions
Migraines and headaches have been
clinically proven to be associated with
trigger points in the head and neck
muscles. Manual and Intramuscular
release of strategic muscles can
dramatically lessen the frequency and
severity of headaches; and in some
cases eliminate them all together.
The rotator cuff muscles are a common
location to find trigger points. The
trigger points create an imbalance in
the dynamics of the shoulder joint. Over
time, this leads to serious conditions
such as rotator cuff tears, impingement
syndrome and frozen shoulder. Manual
therapy can easily release the trigger
points and restore the normal, healthy
balance to the shoulder again.
Tennis Elbow (lateral epicondylitis) &
Golfer’s Elbow (medial epicondylitis)
are conditions that are usually caused
by increased tension in the muscles
of the upper arm and forearm, which
puts excessive strain on the elbow
joint. Once key trigger points are
released with manual therapy, pain is
eliminated and normal joint mechanics
are restored.
Carpal tunnel is irritation of tissues
such as ligaments and tendons in
the hand that press against a nerve
causing pain or numbness. Carpal
tunnel is sometimes brought on by
repetitive movements such as typing
and assembly line work. Many cases of
carpal tunnel that fail to resolve after
surgical carpal tunnel release, will likely
improve with trigger point release.
Hip, Knee, Leg and Ankle/Foot Pain
Hip pain/trochanteric bursitis. Waking
up with hip pain or when you roll
over is a common sign of hip bursitis.
Irritated tissues around the point of
the hip cause the pain. Manual therapy
helps stimulate the soft tissue and
break the painful bands and knots.
Achilles tendonitis is pain along the
back of the heel caused by tight or
overused calf muscles that transfer
the stress of walking or running to the
Achilles tendon. Trigger points in the
gastroc and soleus muscles are almost
always to blame.
Plantar fasciitis involves irritation of
the tissues on the bottom of the foot,
causing pain with standing and walking.
Trigger points in the lower leg and
foot muscles can create tension which
leads to this irritation. Manual and
intramuscular trigger point release can
be very effective in breaking the pain
cycle.
Knee pain does not always correlate
with the degree of arthritis in the
joint. Many times, knee pain is caused
by the large quadriceps muscles that
intersect the joint. If these muscles
harbor trigger points for long periods of
time, bony and soft tissue changes can
worsen. Manual therapy can restore
normal tissue length and balance
the joint for optimal function and
decreased pain.
Hamstring strains are common athletic
injuries involving tearing one or more
of the hamstring muscles. Trigger point
manual therapy can both prevent and
treat this condition.
IT band syndrome is felt as tenderness
along the outside of the leg, extending
down to the knee. Runners or cyclists
commonly experience IT (Iliotibial)
band syndrome. Some factors that
may contribute to the likelihood of this
complaint include excessive mileage
and muscular weakness. Trigger points
in several thigh muscles can increase
tension on the IT Band and must be
treated for complete recovery from
this condition.
Ann Edwards Physical Therapy
844 Washington Road, Suite 209,
Westminster, MD 21157
edwardspt.com |410-868-1708
www.OTaccess.com
Information To Share With Your Physician
The American Physical Therapy Association (APTA) includes intramuscular manual therapy, or IMT (also known
as dry needling or DN), within the professional scope of practice for physical therapists. IMT intervention by a
licensed physical therapist is intended to alleviate functional impairment associated with neuromusculoskeletal
pain.
Summary Research and Indications - As Provided By The APTA*
Articles were reviewed to determine those appropriate for individual expert review. Those articles excluded were: those educational in nature or with
no research design or peer review process, such as lectures, posters, debates, or correspondences, or a Delphi study of practitioners (36); those not on
topic such as electrical stimulation, needle injections without data pertinent to dry needling, or planned studies with no data (57); those without full text in
English (2); those not on human subjects (5); those that had a newer version of the same study (2); and those that were summaries and systematic reviews
or clinical reviews (6). The remaining 46 individual studies were reviewed by a member expert in research analysis using a standardized review form. The
results of the review included 10 case reports (n<10), 1 case series (n>, 10), 12 observational studies, and 23 randomized controlled trials (RCT). These
46 studies were reviewed using a rating scale from 0-5, with 5 indicating the highest level of quality and highest level of support for dry needling. The
median quality of the research was 3; the median support of dry needling was 2. Of the 23 RCTs, again using a rating scale from 0-5, with 5 indicating
the highest level of quality and highest level of support for dry needling, the median quality of the research was 4; the median support of dry needling
was 3. One case study of the 10 noted above was not included in the rating of the evidence. This case addressed an adverse event of a cervical epidural
hematoma from dry needling performed by a physician.
The treatment of myofascial trigger points (referred to as TrPs) has a different physiological basis than treatment of excessive muscle tension, scar tissue,
fascia, and connective tissues. TrPs are hyperirritable spots within a taut band of contractured skeletal muscle fibers that produce local and/or referred
pain when stimulated. TrPs are divided into active and latent TrPs dependent upon the degree of irritability. Active TrPs are spontaneously painful, while
latent TrPs are only painful when stimulated, for example, with digital pressure. TrPs can be visualized by magnetic resonance imaging and
sonography elastography.
Indications:
DN may be incorporated into a treatment plan when myofascial TrPs are present, which may lead to impairments in body structure, pain, and functional
limitations. TrPs are sources of persistent peripheral nociceptive input and their inactivation is consistent with current pain management insights. DN also
is indicated with restrictions in range of motion due to contractured muscle fibers or taut bands, or other soft tissue restrictions, such as fascial adhesions
or scar tissue. TrPs have been identified in numerous diagnoses, such as radiculopathies, joint dysfunction, disk pathology, tendonitis, craniomandibular
dysfunction, migraines, tension-type headaches, carpal tunnel syndrome, computer-related disorders, whiplash associated disorders, spinal dysfunction,
pelvic pain and other urologic syndromes, post-herpetic neuralgia, complex regional pain syndrome, nocturnal cramps, phantom pain, and other
relatively uncommon diagnoses such as Barré Liéou syndrome, or neurogenic pruritus, among others.
*Physical Therapists & The Performance of Dry Needling, An Educational resource Paper, Produced by the APTA Department of Practice and APTA State Government
Affairs, January 2012; Description of Dry Needling in Clinical Practice: An Educational Resource Paper, Produced by the APTA Public Policy, Practice, and
Professional Affairs Unit, February, 2013.
Physical Therapy Rx - Not required for treatment
Ann Edwards: 844 Washington Road, Suite 209, Westminster, MD 21157 | 410-868-1708 | edwards pt.com
Name :________________________________________________________________
Diagnosis:______________________________________________________________
Precautions:____________________________________________________________
Physical therapy orders:
Evaluate and treat
Special Considerations:___________________________________________________
Frequency and Duration:
____ per therapist discretion
or
____ times per week for ____ weeks
Physician signature:___________________________________ Date:______________