Comparison of two angles of approach for trigger point dry needling of the lumbar multifidus in human donors (cadavers).
Man Ther. 2016 Dec;26:160-164
Authors: Hannah MC, Cope J, Palermo A, Smith W, Wacker V
STUDY DESIGN: Descriptive comparison study.
OBJECTIVE: To assess the accuracy of two needle angle approaches for dry needling of the lumbar multifidus.
BACKGROUND: Low back pain is a leading cause of disability around the world; the lumbar multifidus plays a vital role in low back health. Manual therapy such as dry needling can improve pain mediation and motor control activation of the lumbar multifidus. Clinicians practicing dry needling at the lumbar multifidus typically use an inferomedial approach considered non-controversial. Clinicians practicing electromyography and nerve conduction studies commonly sample the lumbar multifidus in a directly posteroanterior approach that may provide another option for dry needling technique.
METHODS: Four human donors were used for a total of eight needle placements-four with an inferomedial orientation and four with a posteroanterior orientation. Each needle was placed from 1 to 1.5 cm lateral to the spinous process of L4 to the depth of the lumbar lamina. Each lower lumbar spine was then dissected to determine the structures that the needle traversed and the needle's final resting place.
RESULTS: All four inferomedial approach needles ended at the lamina of the vertebrae below. All four posterior-anterior approach needles ended in the lamina of the same level.
CONCLUSIONS: All eight needles traversed the lumbar multifidus and ended in the lumbar lamina with little possibility of the needle entering the subarachnoid space. Thus both the inferomedial and the posteroanterior angles of approach are efficacious for clinicians to use in dry needling of the lumbar mulifidus.
PMID: 27669130 [PubMed - indexed for MEDLINE]
Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome.
Man Ther. 2016 Dec;26:62-69
Authors: Koppenhaver S, Embry R, Ciccarello J, Waltrip J, Pike R, Walker M, Fernández-de-Las-Peñas C, Croy T, Flynn T
BACKGROUND: Initial reports suggest that treating myofascial trigger points in the infraspinatus with dry needling may be effective in treating patients with shoulder pain. However, to date, high quality clinical trials and thorough knowledge of the physiologic mechanisms involved is lacking.
OBJECTIVES: To examine the effect of dry needling to the infraspinatus muscle on muscle function, nociceptive sensitivity, and shoulder range of motion (ROM) in the symptomatic and asymptomatic shoulders of individuals with unilateral subacromial pain syndrome.
DESIGN: Within-subjects controlled trial.
METHODS: Fifty-seven volunteers with unilateral subacromial pain syndrome underwent one session of dry needling to bilateral infraspinatus muscles. Outcome assessments, including ultrasonic measures of infraspinatus muscle thickness, pressure algometry, shoulder internal rotation and horizontal adduction ROM, and questionnaires regarding pain and related disability were taken at baseline, immediately after dry needling, and 3-4 days later.
RESULTS: Participants experienced statistically significant and clinically relevant changes in all self-report measures. Pressure pain threshold and ROM significantly increased 3-4 days, but not immediately after dry needling only in the symptomatic shoulder [Pressure pain threshold: 5.1 (2.2, 8.0) N/cm(2), internal rotation ROM: 9.6 (5.0, 14.1) degrees, horizontal adduction ROM: 5.9 (2.5, 9.4) degrees]. No significant changes occurred in resting or contracted infraspinatus muscle thickness in either shoulder.
CONCLUSIONS: This study found changes in shoulder ROM and pain sensitivity, but not in muscle function, after dry needling to the infraspinatus muscle in participants with unilateral subacromial pain syndrome. These changes generally occurred 3-4 days after dry needling and only in the symptomatic shoulders.
PMID: 27497188 [PubMed - indexed for MEDLINE]