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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:______________