I recently attended the annual Spring Conference of the BMAS where we had the good fortune of listening to two presentations by Professor Cesar Fernandez de Las Penas. Almost every slide referenced a journal paper and in order to fully appreciate the wealth of evidence presented I recommend viewing the post conference webcast.
During the following weeks I will share a few posts here that will offer key highlights I took away from the presentations. I am sure you will find them interesting and informative.
Part 1
Myofascial pain syndrome is a consequence of either active or latent myofascial trigger points (MTrP) within muscles. From an aetiological point of view, a dysfunctional motor end plate is considered to be central in explaining the exquisite tender spot found within a muscular taut band and the subsequent referred pain phenomenon all of which are MTrP diagnostic criteria.
When using Acupuncture to treat trigger points, the descriptive term Dry Needling may be used and can be applied in one of two ways. Firstly using two fingers along a taut band the needle is inserted perpendicularly into the MTrP located between fingers.
A second approach involves using a pincer grip, again inserting the needle perpendicularly into the MTrP. This second approach allows for deeper dry needling while retaining control of the anatomy for safety. Once the needle has been inserted it may be near fully withdrawn and reinserted at a varying angulation to reach the area of motor end plate dysfunction. The speed at which the needle should be inserted and withdrawn was discussed with a more rapid insertion and slightly slower withdrawal suggested to avoid a muscle grabbing response. Too slow however risks losing localisation of the taut band.
The aim of needling in this context is to elicit a local twitch response with referred pain, which if familiar to the patient confirms the presence of an active MTrP. The local twitch response was demonstrated very clearly using ultrasonography while a needle was being inserted into a MTrP within the rectus abdominis muscle.
Until Part 2 - Take care,
Simon.
