beyond stretching and ultrasound; current treatments for musculoskeletal injuries julie paolino pt...

Beyond Stretching and Ultrasound;

Current Treatments for Musculoskeletal Injuries

Julie Paolino

PT MS ATC MCTA CIDN

WHERE TO START….

Traditional physical therapy consists of stretching, exercise, massage, heat or ice

But there is more!

NEWER INTERVENTIONS

Dry Needling

&

Therapeutic Taping

DRY NEEDLING

AAOMPT POSITION STATEMENT

“It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist

practice.”

(AAOMPT. Position statement: Dry Needling. American Academy of Orthopaedic Manual Physical Therapists, October 17, 2009.)

WHAT IS DRY NEEDLING AND HOW IS IT EFFECTIVE?

• NOT acupuncture!

• Acupuncture

• Treating disturbances of “Energy Flow”

• Needles are inserted in pre-determined areas in meridians

WHAT DRY NEEDLING IS NOT!

• 2,000 hours education and training in ancient Chinese medicine

• Knowledge of meridians which is not related to modern medical knowledge

• Professional license exam

• 4-5 years of PT education

• Knowledge – anatomy, PNS, physiology, pathology, kinesiology and manual therapy

• Clinical training = 25-50 hours of specialty training depending on model

DRY NEEDLING VS ACUPUNCTURE

Dry Needling Traditional Meridian Acupuncture

Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

WHY WE DRY NEEDLE?

• To decrease pain (local vs referred)

• To Improve function

• To DESENSITIZE the patient’s nervous system (Chronic pain)

What does it do?

EFFECTS OF DRY NEEDLING

NEEDLING EFFECTS:

Creates a lesion which activates physiological mechanisms of remodeling of injured and inflamed soft tissues in and around the needling site

Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

NEEDLING EFFECTS:• Electrical stimulation:

• Rhythmic vibration local and systemic effects

• Non-specific pathophysiologic effects:

• Restores tissue homeostasis thus joint biomechanics are improved

• Precise location of particular points:

• Traditional acupoint or trigger points - ???

• Needling the sensitized or inflamed area

Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

Clinical Limitations

DRY NEEDLING

CLINICAL LIMITATIONS

• Requires the process of homeostasis in order to promote self-healing

• Therefore, if a patient’s self-healing potential is impaired, the response to needling may be limited!!

• Most effective: soft-tissue pains thru localized symptoms

• Less effective: non-soft tissue pain symptoms

Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

AFTER CARE

• Manual Soft Tissue Mobilization

• Joint Mobilization

• Therapeutic Exercise/Stretching

• Corrective Exercise

• Ice or Heat

• Light activity encouraged

IS THERE EVIDENCE TO SUPPORT INTRAMUSCULAR DRY NEEDLING?

DUNNING, J. ET AL. DRY NEEDLING: A LITERATURE REVIEW WITH IMPLICATIONS FOR CLINICAL PRACTICE GUIDELINES. PHYSICAL THERAPY REVIEWS 2014 VOL.19 (4)

• Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs)

• However, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist

• The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature

• Acupuncture’ literature supports the use of ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials

IDN: LITERATURE SUMMARY

• Superficial and deep needling more effective than placebo, or no treatment

• Inclusion of paraspinal points clinically significant versus local needling in isolation

• Needling non-local trigger points reduces pain in primary TrP sites

• Studies support immediate and short term results but need high quality, long term trials

Dr. Ma’s IDN Integrative Dry Needling: Pain Management and Sports Rehabilitation. Course Notes 2014. Dr. Frank Gargano PT, DPT, OCS, CIDN, MCTA, CWT

Traditional taping techniques would restrict and limit movements

THERAPEUTIC TAPING

3 DIFFERENT TYPES

• Mulligan : Mobilzation with Movement

• ROCK Taping / FMT

• Kinesiotaping

MULLIGAN MOBILIZATION WITH MOVEMENT

• Dev by New Zealand physio 1985

• Tape utilized to reposition “joint”

• promote mobility

• increase ROM

ROCKTAPE AND FMT

• Fascial Movement Taping

• Dr. Steven Capobianco

• Greg van den Dries

• FMT goal is to foster proper movement through treatment

• acute injuries

• use in chronic cases

• for prevention and performance improvement and training

• Simple and effective approach

• Stretches along length, but not width

• Recoil effect

KINESIOTAPING• Dr. Kenzo Kase, DC

Developed in 1979

• Exposure 1988 Seoul Olympics, Introduced to US in 1995

• Effects: Skin, Fascia, Circulatory/ lymphatic, Muscle, Joint.

• Uses:

~Mechanical correction

~Fascial correction

~Space correction

~Ligament / Tendon correction

~Functional correction

~Lymphatic correction

• Mechanical Decompression of the skin

EFFECTS OF THE TAPE

• Sensory motor stimulation

• Sensory cortex

• Afferent signals to the brain

EFFECTS OF THE TAPE

• Pain GATE theory

• Support for injured muscles or joints

• Allowing a full, healthy range of movement

EFFECTS OF THE TAPE: DECREASE PAIN

APPLICATION

GENERAL INFORMATION

• Health history and Test patches

• Prior experience w/ taping

• 15 min test patch to assess tolerance

• Sensitive Skin and Allergies

• There is no latex

• Allergic reactive rare

• Irritation created if stretch is placed at the anchors

GENERAL INFORMATION

• Sensitive zones

• Posterior knee

• Neck (anterior and posterior triangles)

• Armpit

• Anterior elbow

• Hands/Feet**

• Compromised skin• Infants

• Elderly

• Pregnant patients (especially 3rd trimester)

• Prone to skin allergies

• Sensitive skin

• Open wounds

• Skin infections, Cellulitis

• Active cancer

• DVT

• Kidney disease

• CHF

GENERAL INFORMATION

Contraindications Precautions

• Ability to wear for up to 5 days (3 days K tape)

• Waterproof, latex free and hypoallergenic

• Do not heat tape!

• Remove if adverse symptoms occur

ROCK TAPE

Step One:

Eccentrically Load Area

Step Two:

Stabilize Area

Step Three:

Decompression Strip(s)

ROCKTAPE

KINESIOTAPE • To Inhibit a muscle

~DistalProximal (I to O)

~Inhibit: Acute injuries, muscle spasm

~15% to 25% Tension

• To Facilitate a muscle~ProximalDistal (O to I)

~Chronic conditions, weak

~15% to 50% Tension

KINESIOTAPE TAPE TENSION

Paper off tension: 10-15%

Light 15-20%

Moderate 25-50%

Severe 50-75%

Full 75-100%

0%: NO TENSION ON ENDS (ANCHOR)

KINESIOTAPE STRIPS

• I strip: Applied directly over area to be treated

• Y Strip: Anchor and two tails: Surround muscle to be treated.

• X Strip: Can be used for muscles that cross 2 joints, Star for contusion, muscle sprain / Tear.

• Stretch middle 1/3rd of “X” placed over muscle belly.

• Fan Strip: Lymphatic issues.

~Anchor in areas of lymphatic system. Cut 3-4” long strips. Place through area of swelling with Nil to paper off tension.

~Criss-cross fans through Rx area, anchor on each side of joint

EFFECTS OF TAPE: DECREASE PAIN

• Support for injured muscles or joints

• Allowing a full, healthy range of movement

EFFECTS OF TAPE: DECREASE EDEMA

• Enhanced blood flow

• Decreases pressure on pain receptors

• Improved lymphatic drainage will help minimize swelling and bruising

LYMPHATIC CORRECTION

THE TRAINING ROOM

• To support sport-specific fascial chains

• Better engage and coordinate movements

• Increase efficiency

• Reduce fatigue

Ankle Sprain/Prevention

NOTHING IN THE UNIVERSE IS STATIC. EVERYTHING MOVES.

THE HUMAN BODY IS NO EXCEPTION.

Questions?