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Beyond Stretching and Ultrasound;
Current Treatments for Musculoskeletal Injuries
Julie Paolino
PT MS ATC MCTA CIDN
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WHERE TO START….
Traditional physical therapy consists of stretching, exercise, massage, heat or ice
But there is more!
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NEWER INTERVENTIONS
Dry Needling
&
Therapeutic Taping
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DRY NEEDLING
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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.)
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WHAT IS DRY NEEDLING AND HOW IS IT EFFECTIVE?
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• NOT acupuncture!
• Acupuncture
• Treating disturbances of “Energy Flow”
• Needles are inserted in pre-determined areas in meridians
WHAT DRY NEEDLING IS NOT!
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• 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
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WHY WE DRY NEEDLE?
• To decrease pain (local vs referred)
• To Improve function
• To DESENSITIZE the patient’s nervous system (Chronic pain)
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What does it do?
EFFECTS OF DRY NEEDLING
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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
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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
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Clinical Limitations
DRY NEEDLING
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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
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AFTER CARE
• Manual Soft Tissue Mobilization
• Joint Mobilization
• Therapeutic Exercise/Stretching
• Corrective Exercise
• Ice or Heat
• Light activity encouraged
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IS THERE EVIDENCE TO SUPPORT INTRAMUSCULAR DRY NEEDLING?
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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
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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
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Traditional taping techniques would restrict and limit movements
THERAPEUTIC TAPING
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3 DIFFERENT TYPES
• Mulligan : Mobilzation with Movement
• ROCK Taping / FMT
• Kinesiotaping
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MULLIGAN MOBILIZATION WITH MOVEMENT
• Dev by New Zealand physio 1985
• Tape utilized to reposition “joint”
• promote mobility
• increase ROM
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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
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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
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• Mechanical Decompression of the skin
EFFECTS OF THE TAPE
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• Sensory motor stimulation
• Sensory cortex
• Afferent signals to the brain
EFFECTS OF THE TAPE
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• Pain GATE theory
• Support for injured muscles or joints
• Allowing a full, healthy range of movement
EFFECTS OF THE TAPE: DECREASE PAIN
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APPLICATION
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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
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GENERAL INFORMATION
• Sensitive zones
• Posterior knee
• Neck (anterior and posterior triangles)
• Armpit
• Anterior elbow
• Hands/Feet**
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• 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
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• 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
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Step One:
Eccentrically Load Area
Step Two:
Stabilize Area
Step Three:
Decompression Strip(s)
ROCKTAPE
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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
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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)
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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
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EFFECTS OF TAPE: DECREASE PAIN
• Support for injured muscles or joints
• Allowing a full, healthy range of movement
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EFFECTS OF TAPE: DECREASE EDEMA
• Enhanced blood flow
• Decreases pressure on pain receptors
• Improved lymphatic drainage will help minimize swelling and bruising
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LYMPHATIC CORRECTION
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THE TRAINING ROOM
• To support sport-specific fascial chains
• Better engage and coordinate movements
• Increase efficiency
• Reduce fatigue
Ankle Sprain/Prevention
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NOTHING IN THE UNIVERSE IS STATIC. EVERYTHING MOVES.
THE HUMAN BODY IS NO EXCEPTION.
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Questions?