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Monthly Archives

August 2018

Dry needling – No need for needle phobia

dry needling

Dry needling helps with managing musculoskeletal pain, functional movement and postural complaints. Myofascial pain is probably the most common condition physiotherapists see worldwide. It affects ups to 10% of the adult population and can account for acute and chronic pain complaints. Commonly myofascial pain results in trigger points, which are typically recognized by palpable nodules in taut bands of tissue. The perpetuating factors of myofascial pain syndromes are low-level musculature contraction, unaccustomed eccentric contraction, muscle overloads, and muscle fatigue.

These factors can be caused by, but not limited to:

  • mechanical dysfunctions such as forward head postures
  • joint hypermobility
  • ergonomic stressors
  • poor body mechanics
  • Scoliosis.

 

What is Myofascial?

As far back as the 16th century, myofascial pain syndromes have been recognised as causing sensory, motor and autonomic symptoms and dysfunctions. However, it wasn’t until the 1900’s that it was discovered that the origin of myofascial pain was the trigger points and that the stimulation of the trigger point referred pain. Initially, injection of an analgesic medication into the trigger points produced a decrease in a patient’s symptoms, pain, and the sensitivity to touch of the trigger points. Further research discovered that the actual insertion and stimulation of the muscle with a dry needle produced pain relief without the need for medication. Thus, the development of trigger point dry needling began.

Myofascial trigger point dry needling has no similarities with traditional acupuncture except for the tool being used during the process. Traditionally, acupuncture is based upon Chinese medicine that seeks to regulate flow and stability of energy through subcutaneous placements of needles. Acupuncture points are points mainly along the paths of energy flow (or meridians). In contrast, trigger point dry needles are inserted into specific musculature, targeting tight muscles, and based on neuromuscular and biomechanical principles.

 

The Dry Needling technique

Studies have found that inserting a dry needle into a trigger point is a very effective way to release trigger points. The theory behind the dry needling technique comes from Dr Chan Gunn, who contributed to the development of dry needling and introduced the term intramuscular stimulation (IMS), in which he described that myofascial pain syndromes are a result of radiculopathy or peripheral neuropathy, causing a disordered function of the peripheral nerve.

This concept is referred to as the radiculopathy model and is based on the Cannon and Rosenblueth’s law of denervation, which states that free flow of nerve impulses maintains innervated function and integrity of structures. When any neural flow is disrupted, all the structures that are innervated by that nerve, such as skeletal muscle, smooth muscle, spinal neurons, sympathetic ganglia, and sweat glands, are affected and can become atrophic, highly irritable, and hypersensitive. The trigger point model describes myofascial trigger points consisting of taut musculature bands due to the excessive release of acetylcholine. Myofascial trigger points are classified as active or latent.

Active myofascial trigger points can cause local and referred pain, or other parasthesias, whereas latent myofascial trigger points may not produce pain without being stimulated. Active myofascial trigger points typically refer pain to a particular site, and these sites are not restricted to a single segmental or peripheral nerve distribution. Clinically, myofascial trigger points can cause motor dysfunction or muscle weakness as a result of motor inhibition, restricted motion, and muscular stiffness. Furthermore, sensory dysfunctions may be noted through localized tenderness, referral of pain to specific areas, hyperalgesia, and/or allodynia.

 

What treatment can you get from dry needling?

The goal of dry needling is to produce a twitch response (short contraction) of the muscle being needled. The twitch of the muscle is the desired response; however, benefits can occur even without a twitch of the muscle. The simple insertion of the needle into the taut bands can interrupt the pathogenic process and produce mechanical changes in the tissue. The insertion of a needle into the trigger point can produce a deep ache or cramping pressure that lasts only briefly. Reproduction of pain and referral of symptoms may also occur, and soreness may last up to 24–48 hours. Improvements in functional range of motion, decrease in complaints of pain, and ease of mobility may be seen after treatment.

Trigger point dry needling is a relatively new technique in physiotherapy. Internationally, Australia, Belgium, Canada, Chile, Denmark, Ireland, The Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, and Switzerland have recognized trigger point dry needling to be within the scope of practice for a physical therapist.

Clinically, The Body Refinery physiotherapists have found dry needling to be very effective in managing pain in both acute and chronic patients. Our Physiotherapists have also found dry needling to be highly effective in clients with movement and postural complaints. It is a quick easy way to release muscle trigger points prior to therapeutic exercises and the release is maintained well by exercise.

 

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Book an appointment with a Physiotherapist today on 07 3358 3915 or at info@thebodyrefinery.com.au

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Neck pain and Pilates: the benefits and effects on posture

Neck Pain

Neck pain is a relatively common complaint. It affects up to 70% of individuals in their lifetime. International statistics show that around 10-15% of the population has neck pain at any given time. No age group or occupation appears immune and neck pain is second only to low back pain in annual workers compensation costs in Australia. Neck pain tends to be a persistent and recurrent disorder and up to 60% of persons can expect some degree of ongoing pain for many years after their first episode. The pain intensity can range from mild to severe.

Many treatments for neck pain have been found to be ineffective for relieving acute neck pain but Pilates combined with Physiotherapy has been found to be one of the most effective treatments for acute neck pain.

 

There are several principles that underlie the Pilates  approach to neck pain:

 

  • Clinical Pilates commences early in the 
rehabilitation process, usually within the patient’s initial 
presentation
  • Pilates should not provoke neck pain
  • Pilates exercises are designed to address the specific changes 
identified in the muscle system and in sensorimotor function
  • Muscles are trained specifically and within a functional and task-specific context
  • Repetition is essential in the learning process to establish or re-establish appropriate movement and muscle control
  • Patients must understand the rationale underpinning the various components and phases of the exercise approach. Their contribution to, and compliance with, the Pilates program is critical to the learning process.

These principles are derived from the evidence of the rapidity of onset of changes in sensorimotor function, the changes in muscle activity in response to pain, the specific changes in the muscles’ properties in association with neck pain, as well as the evidence for specificity in exercise to address the often complex and various impairments that may be present in a patient’s presenting disorder.

 

Neck pain

 

The exercise program described is a staged program, which progresses through three basic phases

 

Stage 1:The first phase of the exercise program, as indicated, aims to activate and train the deep cervical and axioscapular muscles with precise exercises and to integrate their actions into their functional supporting role in an upright posture. Low-load endurance exercises are introduced to train the deep muscles in line with their functional supporting role. Stage 1 focuses on motor learning and specificity of exercise to address the impaired muscle function in those with neck pain.

Stage 2:The exercise program in stage 2 continues to have a focus on motor learning but also begins to add load in both the formal and functional exercises of this stage.

Stage 3: This phase focuses on strength and endurance training. This phase should be approached with some caution from both muscle control and symptom perspectives.

 

How we can help

 

An appropriate well-constructed exercise program is mandatory in the rehabilitation of patients with cervical disorders to assist optimal recovery as well as attempt to intervene into the transition to recurrent or chronic pain.

Clinical Pilates addresses all 3 stages of the rehabilitation exercises. Pilates principles focus on posture and body awareness so clients are able to go from rehab phase into maintenance using the same exercises.

The Body Refinery, offers physiotherapist who are highly trained in manual therapy as well as clinical Pilates making the environment ideal to manage clients with acute and chronic neck pain and whiplash related disorders.

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Book an appointment with a Physiotherapist today on 07 3358 3915 or at info@thebodyrefinery.com.au.

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