Here is the abstract from a recent journal article highlighting the results of the study. Take home message: Frozen shoulder aka adhesive capsulitis is classically considered a "joint issue". Dry Needling aims to influence mainly "muscle dysfunction". What "joint issues" do you have that needling can help???
Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder
Authors: Derek Clewley, PT, DPT, OCS, FAAOMPT, Timothy W. Flynn, PT, PhD, OCS, FAAOMPT, Shane Koppenhaver, PT, PhD, OCS, FAAOMPT
Published: Journal of Orthopaedic & Sports Physical Therapy, 0, Volume: Early Access Issue: Early Access Pages: 1-32 doi:10.2519/jospt.2014.4915
Background: Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1-3 years. Conservative treatment including physical therapy is commonly advised.
Case Description: The patient was a 54 year old female with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to cause some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid and infraspinatus muscles that were treated with dry needling to decrease pain and allow for higher grades of manual intervention.
Outcomes: The patient was treated for a total of 13 visits over a 6 weeks period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures, including SPADI and QuickDASH, exceeded the minimal clinically important difference after 2 treatment sessions. At discharge the patient had achieved significant improvements in shoulder range of motion in all planes and outcome measures were significantly improved.
Discussion:This case report describes the clinical reasoning behind the use of trigger point dry needling in the treatment of a patient with adhesive capsulitis. The rapid improvement seen in this patient following the initiation of dry needling to the upper trapezius, levator scapula, deltoid and infraspinatus muscles suggests that surrounding muscles may be a significant source of pain in this condition.
Keyword: frozen shoulder, soft tissue, upper trapezius
Read More: http://www.jospt.org/doi/abs/10.2519/jospt.2014.4915#.UpuaHxYyClI
LIVING WELL: Kennedy's back problems led to treatments today
By: DR. MARK KESTNER, Post Columnist
Posted: Monday, December 2, 2013
Many readers know that President John F. Kennedy was plagued by chronic back pain.
The little known story of how he found helpful treatment has ramifications in the treatments available today.
When Kennedy was a senator, he was introduced to an unconventional medical doctor named Janet Travell.
At the time, Travell was busy researching common and uncommon treatments to help with back pain as well as other sources of chronic pain.
Travell had discovered that much of chronic pain originates from hardened, tender knotty areas in the muscles.She had been experimenting with various forms of injections into these localized nodules. At one point she discovered that certain methods of stimulating the nodule with a dry needle (one that contained no medication) actually worked well to alleviate pain.
When Kennedy came to see Travell in the late 1950s, this was the treatment that he was provided.
Travell’s treatment was so effective that when Kennedy was elected president, he asked Travell to become the first female White House physician.
Travell’s pioneering work with Kennedy is still relevant today. The treatment has been refined and become known as dry needling or intramuscular stimulation. Earlier this month while teaching a seminar for doctors learning to use dry needling as a treatment for chronic pain, I mentioned that those of us gathered in the training room would not be there except for the work of Travell.
Perhaps her work would have become as widely know if she had not provided care for such a famous patient as Kennedy, or perhaps not.
Today chiropractors, physical therapists and other pain practitioners around the world can attribute a major part of their successful treatment for chronic pain directly to Travell.
When a patient undergoes dry needling therapy today, hypodermic syringes are no longer used.
To perform trigger point dry needling, I gently insert a very fine, solid, sterile needle directly into the most sensitive area of the affected muscle. Amazingly to patients, it is surprisingly comfortable.
When the needle is inserted, it has several benefits. Some responses are immediate while others take a few hours or days.
For the seminar I taught at my office, I asked several current patients if they would mind being videoed for demonstration purposes. In each case, the patient was able to demonstrate an increased pain-free range of motion within seconds of receiving the dry needling therapy.
This is due to a neurological effect of the needling that affects the spinal cord and the brain. In most cases, patients will continue to see gradual improvements over the next few days after receiving trigger point dry needling.
This is believed to be due to the fact that the needling creates new minute lesions within the chronically affected tissues, and the body initiates a new healing response that is effective in reducing the painful restrictions caused by the chronic condition.
There are several important keys to successful treatment of chronic pain using dry needling. The first is arriving at an accurate diagnosis.
One might think that diagnosing chronic pain would be a straightforward process. It is not. Over the years I have found many cases in which the diagnosis that a patient has been given is inaccurate. In many cases, chronic pain may appear to be arising from a particular structure, when in fact a different nearby structure is the main culprit.
This is commonly the case when dealing with muscular trigger points.
Trigger points are notorious among clinicians for referring pain to an adjacent location. This make diagnosis more confusing if the doctor is not well-trained in evaluating and treating myofascial trigger points.
The second important aspect of successful trigger point treatment is in precise and proper needling. Dry needling need not be painful in most cases. Precision and specificity in determining the exact location and angle of needle insertion can alleviate much if not all of the discomfort.
Thanks to the innovative work of Kennedy’s private physician, Travell, trigger point dry needling is now widely available and often highly successful for patients with chronic pain.
http://www.murfreesboropost.com/living-well-kennedys-back-problems-led-t...
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Excerpt from Golf Digest Article:
I'm really proud of these pictures. The "good" positions are the result of a fairly intense rehab project I started last fall after hurting my back. I know what some of you are probably thinking: How does a 24-year-old have back problems? Talk to me when you're my age, kid. Well, if you play a lot of golf, a bad swing habit will exact a physical toll no matter your age or fitness level. In my case, I was placing extreme pressure on my lower spine from rotating my hips too much. This is a common cause of bad backs--and bad shots--for golfers of all levels. In addition to resting, I worked with my trainer, on strengthening the weaker lower-body muscles that contributed to my overactive hips and back pain. Because I've spent more time fixing my swing at the gym than on the range, I'm confident the results will be lasting.
Access more of the article here: http://www.golfdigest.com/golf-instruction/2013-05/photos-rickie-fowler-fix-swing#intro
Unfortunately, low back pain is all too common in golfers, both pro and amateur. Movement’s Medical Golf Evaluation & Human Performance Enhancement system was developed to also remedy this type of issue. The concept is simple: we first identify problems within the golf swing via video analysis. How the body moves outside the swing is then analyzed--a comprehensive look at mobility versus strength from head to toe. Lastly, movement patterns related to the golf swing deemed broken are fixed. Not surprisingly, pain goes out the window and so do bad shots!
The best way to get prepped for a workout is likely different than you think. If you think stretching your hamstrings is what you should be doing then I promise you’re missing the boat. Take a look at these videos and notice the progression from simple to complex movement; it looks like the first year of a human life! There is no better way to get prepped for swinging a golf club, lifting a weight, running, jumping, etc. than to build up to it--that’s how your body did it originally. These moves are primal, natural, authentic, and absolutely necessary. Mastering the movement patterns in these videos will establish a solid foundation that lowers your risk of injury and improves performance with your resulting workout...and just life in general.
1. Titleist Performance Institute 4x4 Matix
One caveat: Earn the right to do these moves by first removing mobility/flexibility issues. So maybe you do need to stretch your hamstrings…find out by having an evaluation at Movement!
Many sports related injuries ARE indeed preventable. This magazine article highlights the use of the Functional Movement Screen in BJJ.
Medical research indicates human movement asymmetries, balance, mobility/flexibility, and strength are all important. Irregardless of the sport, your risk of injury can be tested for by using the Functional Movement Screen and other functional tests that have been well researched. These tests capture all of the above important physical factors. Many professional sports teams and organizations are now using these same screens. Dr. Scott Wacker at Movement PT is the only local therapist advanced certified in the FMS and uses it as part of his Injury Prevention Physical. Find out more here.
After months of backorders, Movement now has all of the MELT supplies in and ready for individual and group treatment sessions!
The following are also available for purchase:
MELT Roller $60
MELT Mini Hand/Foot Kit $30 (not available online)
MELT Full Hand/Foot Kit & Instructional DVD $50
Find out more about MELT by clicking here.
Some of my favorite corrective exercises. Great video resources linked below:
Kettlebell Turkish Getup:http://www.youtube.com/watch?v=2vWKMuDH528
Kettlebell Deadlift:http://www.youtube.com/watch?v=2cwGRCnmgag
Kettlebell Swings:http://www.youtube.com/watch?v=fg6r-v7hv-w&feature=fvwp
StrongFirst Kettlebell Standards:https://www.youtube.com/watch?v=l5qB0nILpko
Tom House Postural/Shoulder Exercises:http://www.youtube.com/watch?v=4QuMElyTlVQ
MovNat from Breaking Muscle (start of 4 week program):http://breakingmuscle.com/strength-conditioning/strength-conditioning-erwan-le-corre-week-1-day-1
Titleist Performance Institute 10 Great Exercises for my Golf Swing:http://www.mytpi.com/gfa/online-episodes.asp
Spikey Ball Exercises:http://www.totalgolfanalysis.co.uk/download/Article-FullSpikey.pdf
Vertigo: BPPV Left: http://www.youtube.com/watch?v=kvo19ARl848; BPPV Right:http://www.youtube.com/watch?v=2Vajvoa4_wY
And Don't Forget Self-Limiting Exercises:
By Gray Cook from this link http://graycook.com/?p=1119#comments
Self-limiting exercises make us think, and even make us feel more connected to exercise and to movement. They demand greater engagement and produce greater physical awareness. Self-limiting exercises do not offer the easy confidence or quick mastery provided by a fitness machine.
The earliest exercise forms were self-limiting—they required mindfulness and technique. Idiot-proof equipment and the conditioning equivalent of training wheels did not exist. Great lifters learned to lift great; great fighters learned to fight great; great runners learned to run great. Their qualities and quantities were intertwined.
Self-limiting exercise demands mindfulness and an awareness of movement, alignment, balance and control. In self-limiting exercise, a person cannot just pop on the headphones and walk or run on the treadmill, fingering the playlist or watching the news on a well-placed monitor. Self-limiting exercise demands engagement.
The clearest example of self-limiting exercise is barefoot running. While running barefoot, the first runners connected with the sensory information in the soles of their feet. This works perfectly—this is the very reason the soles of the feet have such a uniquely dense distribution of sensory nerves. This provides a window to our environment, like the nerves in our hands, eyes and ears. The information provided by sensory nerves in the soles help all who walk on two feet continually adjust their movement, stride, rhythm, posture and breathing to meet changes in the terrain.
The modern running shoe allows us to ignore a sensory perspective of running that is only second to vision, and, as you know, the increase in running-related injuries paralleled running shoe development. When running barefoot, over-striding and heel striking is not an option—it produces jarring, discomfort and pain because it is not authentic. Is it not a bit peculiar that the quick twinges of pain refine the barefoot runner’s stride to help avoid running injuries, while the comfort of the modern running shoe later exchanged those friendly twinges for debilitating pain?
The modern runner uses braces to cover a weakness, often not taking responsibility to rehabilitate a problem, or dissatisfied with the rehabilitation process and its incomplete outcome. Christopher McDougall reveals this concept in an amazing story in his book Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, a story that reminds us to temper all technologic advancements against historical facts and time-tested principles. He touches on medical and biomechanical issues, prehistoric man, exercise concepts and a detachment from the joy of movement we exchange for superficial results.
This book is highly recommended for trainers, coaches and rehabilitation professionals to help them see their respective professions through the eyes of the inquisitive, chronically injured runner. Christopher’s investigation and story connects important dots we can all appreciate. In his journey, he discovered rehabilitation and coaching wisdom that is logical and simple. The problem is that he had to dig to find it. Part of his digging was caused by our incomplete practices of movement assessment, exercise and rehabilitation.
Examples of other natural, self-limiting categories are governed by breathing, grip strength, balance, correct posture and coordination. Some exercises combine two or more self-limiting activities, and each has natural selective and developmental benefits. These exercises produce form and function while positioning the entire movement matrix for multiple benefits. As we train movement, anatomical structures model themselves around natural stresses.
Self-limiting activities should become the cornerstone of your training programs, not as preventive maintenance and risk management, but as movement authentication—to keep it real. The limitations these exercises impose keep us honest and allow our weakest links to hold us back, as they should.
Used correctly, self-limiting exercises improve poor movements and maintain functional movement quality. These exercises are challenging and produce a high neural load, which is to say they require engagement and increased levels of motor control at the conscious and reflexive level.
Anytime we don’t acknowledge our weakest links or confront them in training, we demonstrate the same behavior that caused our collective functional movement patterns to erode in the first place. Embedded in each workout, the self-limiting activities continually whisper the message that we cannot become stronger than our weakest links.
A word of caution: These activities are not magic. They don’t automatically install movement quality. They simply provide the opportunity should the individual be up to the challenge. Each of these activities imposes natural obstacles and requires technical attention. There is usually a coordination of attributes not often used together, such as balance and strength or quickness and alignment. These activities usually require instruction to provide safety and maximize benefits. If you do not respect them, they can impose risk.
However, patience, attention to detail and expert instruction will provide a natural balancing of movement abilities. These do not have to make up the entire exercise program. Instead, they offer mental and physical challenges against natural limitations and technical standards. These activities will not only provide variety, but should ultimately produce physical poise, confidence and higher levels of movement competence.
MELT creator Sue Hitzmann on Dr. Oz on Friday, February 15th.
Here is the video:http://www.doctoroz.com/videos/sue-hitzmanns-pain-melting-workout
Experience MELT with Dr. Megan Wacker. She is the only therapist in Eagle County that is MELT certified. Call us for more details!
Movement Physical Therapy offers the only medically researched injury prevention system in the Vail Valley. Save yourself from serious injury this year!!!
See details on the link below and contact us to find out more.