Treating Knee Osteoarthrosis - Segmental and Trigger Points In A Medical Acupuncture Context

When using Medical Acupuncture in the treatment of musculoskeletal pain, I find myself in the main selecting either segmental points or trigger points if present, sometimes both.

Segmental points are basically those where tissue, preferably muscle, which shares the same segmental innervation as the structure likely to be responsible for nociceptive input, is stimulated. Trigger points must meet with the relevant diagnostic criteria and when using Medical Acupuncture to deactivate may be referred to as dry needling. These terms are often used interchangeably however, at least in Europe.

One of the conditions for which I find segmental Acupuncture particularly useful is that of knee osteoarthrosis and associated pain symptoms. The evidence would generally support using more local to the knee joint (White, 2007) and I would select points within muscles which act on the knee joint as well as sharing the same segental innervation. That said, so called sham Acupuncture can also be beneficial in providing pain relief and often extra-segmental points, those outside the segment, are used to augment the effects of segmental points.

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Dry Needling Techniques For Frozen Shoulder – What Works For Me

Frozen shoulder, otherwise known as adhesive capsulitis, is one of those tricky conditions which I have found respond well to treatment, but patience is required. I am a physiotherapist who likes to see quick results, either objectively or subjectively, ideally both!

However as we all know, the pathophysiology of the frozen shoulder often does not lend itself to such expectations and at the outset and it is important to make the patient aware of this fact.

That said, if the correct treatment approach is applied in the correct manner at the correct stage, the speed at a which a frozen shoulder may resolve (compared to no treatment or ‘wait and see’) can be increased significantly.

Conventional wisdom and anecdotal evidence would suggest a frozen shoulder left alone may burn itself out and resolve spontaneously in 12-24 months. With an integrated physiotherapy approach, in most cases my clients have returned to full pain free function after 3-4 months of treatment, weekly at first and then staggered sessions after about 4-6 sessions.

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The Placebo Response In Dry Needling

The placebo response is a psychobiological phenomenon we should use to good effect.

Like it or not, everything we do as physiotherapists has a placebo effect or exerts what may be referred to as ‘non specific effects’.

Whether it is manual therapy, exercise, electrotherapy or dry needling there always has been and always will be a portion of the therapeutic effect which is not necessarily specifically related to the technique itself and which relies on context, expectation, the quality of the therapeutic relationship and so on.

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The Effects of Dry Needling on Fascia

As dry needlers, the implication is usually that we are targeting muscle tissue, more specifically trigger points within taut bands of muscle. Typical dry needling involves an axial lift and thrust type technique where the needle is near fully withdrawn and reinserted at and angle of about 20-30 degrees off the vertical in different directions. The aim with this more vigourous approach is to locate the trigger point and elicit a local twitch response, thought to be key to the therapeutic effect of needling. Rotating the needle while within the muscular taut band or trigger point is also taught on dry needling courses as a method of direct, local stretching.

There are other ways to approach needling trigger points which may be more superficial but usually still penetrating the muscle tissue. Baldry (2005)  would describe 'leaving the needle in situ for some time but also intermittently twirling it' as a way of progressing treatment should short duration, superficial needling with no added stimulation be insufficient to elicit the desired clinical effects.

This technique of twirling or rotating either in a uni-or bidirectional manner is also commonly used as a method of providing added stimulation in more traditional approaches to Acupuncture.

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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


Image courtesy of Primal Pictures Anatomy for Acupuncture

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