Dry Needling The Psoas Major - Why Should We Bother?

First up, lets consider the function of the psoas major muscle. As well as being a primary hip flexor, it may also assist with lumbar extension in someone with a normal lordosis by forward tilting the pelvis. It assists flexion of the spine when bending as well as some external rotation of the hip. This has some bearing on how best to stretch the psoas which should not only include extension but also some internal rotation. This muscle has also been considered a stabiliser of the spine and hip joint and contributes to upright posture in sitting and standing.

As a pain referral source we often think of the psoas major referring to the anterior thigh and groin, but must remember that pain may also be projected in a vertical direction in a ‘gutter’ along either side of the lower lumbar spine as well as to the sacroiliac region and buttock (Travell & Simons, 1999

Psoas-image

Image courtesy of Primal Pictures Anatomy for Acupuncture

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Part 3. Dry Needling for Myofascial Pain - a Mechanisms Review

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.

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Dry Needling for Myofascial Pain - a Mechanisms Review Part 2

This is part 2 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.

Part 1 can be viewed here...

With regards dry needling ‘mechanisms of action’ two main hypotheses were discussed:

Firstly a mechanical mechanism whereby the needle tip ‘destroys’ the dysfunctional motor end plate resulting in deactivation of the MTrP. This hypothesis is supported by evidence which shows a 60-70% decrease in local electrical activity within the end plate zone after dry needling. A certain amount of muscle damage has also be shown to occur, however 28 hours after dry needling the muscle morphology is restored to normal based on histological analysis. The normalisation of motor end plate activity after dry needling may partly explain a reduction in local muscle tone, amelioration of the local twitch response and improved muscle function.

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Part 1. Dry Needling for Myofascial Pain - a Mechanisms Review

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.

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How Do Our Patients Really Feel About Acupuncture?

The objective of this very interesting qualitative study by Stomski et al (2013) was to explore the experience of Acupuncture care from the perspective of people with chronic low back pain. For a change we are given some very interesting information about how our patients perceive, feel about and interpret Acupuncture treatment as opposed to simply focussing on objective outcome measures such as pain scores etc.

As a quick aside, for those of you who have not already read Peter O’Sullivan’s paper discussing the need to reevaluate how we manage chronic low back pain, I’d thoroughly recommend doing so given its relevance to this article

As a clinician who uses Acupuncture partly as a facilitatory technique, one which allows us to more easily influence unhelpful thoughts and behaviours relating to pain, such a study can provide useful information to help guide us based on the patients subjective experience.

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