This is part 3 in a series of blog posts where I am sharing key highlights I took away from presentations, by Professor Cesar Fernandez de Las Penas, at the recent annual Spring Conference of the BMAS.
Be sure to read the previous articles in this series:
From a clinical point of view it was noted the successive daily application of dry needling could result in excessive muscle damage based on rat studies and should be avoided. If a MTrP recurs after one session of needling where a local twitch response has been successfully elicited this would imply the cause has not been addressed. In this case treatment should be repeated making sure any perpetuating factors are addressed.
Professor de Las Penas then ran through some of the more recent research findings telling us that dry needling for myofascial shoulder pain is more effective than usual care and that dry needling MTrP of the pelvic floor muscles is one of the more clinically effective techniques for chronic prostatitis. Dry needling has also been shown to be efficacious for neck pain of myofascial origin with grade A1 evidence now available. In terms of which patients are likely to respond to dry needling, there is evidence to suggest that higher levels of pain along with sleep and psychological disorders are negative prognostic factors.
Dry needling for neurological conditions such as stroke may have therapeutic value based on preliminary studies. Hemiparetic shoulder pain with associated MTrP may respond favourably to dry needling. It has been found that in addition to central alterations in muscle tone and reflex activity, stroke patients also experience muscle fibre specific alterations in muscle tone suggesting a possible benefit from dry needling if these muscle fibres are targeted. A very interesting ultrasonography video clip demonstrated dry needling of a stroke patient’s infraspinatus muscle which instead of eliciting a local twitch response elicited a marked global twitch response involving a significant portion of the muscle. Another video was shown of a significant increase in shoulder abduction after a single session of shoulder dry needling and physical therapy on a patient who has suffered a head injury. Professor de Las Penas is soon to publish a study investigating the effects of dry needling to hypertonic soleus muscles in stroke patients and the effect on ankle plantar flexion strength. It was concluded that dry needling could form part of an integrated approach to managing complex neurological conditions pending further research in this area.
Finally we were informed of a collaborative MTrP dry needling safety model which is being developed to provide guidelines for safe needling practice as well as a nice summing up of the presentation with a mention that MTrP’s are one piece of pain pathway and dry needling is but one technique and not the only one!
By Simon.
