Tag Archives: Functional Dry Needling

Headaches and TMJ Pain: Elite PT Newsletter Sept. 2018

This month I want to talk a bit about treating chronic headaches and temporomandibular joint pain (TMJ – aka the jaw).

But first I want to use this opportunity to remind you that we do free screenings for high school athletes with nagging injuries.  Sprains and strains as well as aches/pains that just don’t get better or go away with time are a perfect example of the kinds of injuries that we could help with.

If you’re son or daughter has a more severe injury then you should consult with your physician first.

I’m available most Tuesday afternoons after 1pm.  Appointments typically run about 30 minute – within that time I can give you a diagnosis and get your athlete started on the path to recovery.  Other days and times may be an option, it just depends on our availability.  Just call us at 231 421-5805 if you have questions or to schedule a free screening.

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In other news….

Anniversaries this month:

Allie Hoyt PT/Athletic Trainer -1 year

Allie Hoyt DPT, ATC
 

 

 

 

 

 

 

Jesie Bott ATC/Massage Therapist- 5 years

Jesie Bott ATC, LMT

 

 

 

 

 

 

Jesie and Allie have been wonderful employees and we’re blessed to have them practicing at Elite Physical Therapy.

They are also a big part of the reason why we have just passed our 7th year in business.  I’m convinced we’ve done so well over the years because of our employees and their love for our patients and desire to help them achieve their recovery goals.
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Headaches and TMJ Pain

These may not be the first things that pop into your head when you think of what a physical therapist would treat but we do see folks with both of these conditions.

Headaches and migraines can sometimes be the result of pain being referred from muscles in the neck up into the head.  It’s way more common than you might think.  The pictures below show the common referral patterns from our neck muscles.

Upper Trapezius

Upper Trap Trigger Points - headaches
 

 

 

 

 

 

 

Suboccipitals

Suboccipital Trigger Points - headaches

 

 

 

 

 

Sternocleidomastoid

Sternocleidomastoid Trigger Points - headaches
 

 

 

 

Long hours staring at a computer screen or hunched over a desk can strain these muscles causing pain.  Often times the muscle itself just feels tight but it projects the pain elsewhere – in this case into your head and/or face.

Luckily its pretty easy for us to determine if this is the cause of your neck pain or headaches. And if that’s the case these muscles can be treated with a number of manual techniques such as Trigger Point Dry Needling and Graston Technique.

  •  click on Dry Needling or Graston Technique above to see video demonstrations

Many people can also have symptoms in the their jaw, or temporomandibular joint (TMJ), which are common with everyday activities like chewing and talking.  The pain can be local to the joint itself and/or the muscles around the joint can refer pain into the head or face.  Check out the pictures below:

Temporalis Muscle

Temporalis Trigger Points - Headaches

 

 

 

 

 

 

 

 

Masseter Muscle

Masseter trigger points - headaches

 

 

 

 

 

 

 

 

TMJ symptoms can also be treated with physical therapy techniques including the manual therapy techniques I mentioned above.  It might sound crazy using needles to treat these muscles but over the past month we’ve had 2 clients that achieved complete pain relief with 1-2 treatment sessions.

There is still a bit of work to do in regards to improving the function of the jaw and neck to be sure the symptoms don’t come back but treating the muscles can be a very beneficial strategy.

If you suffer from chronic headaches or TMJ symptoms give us a call and we can discuss if physical therapy would be appropriate (231 421-5805).
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That’s it for this month.  Talk to you again in October!

Joe Heiler PT
Joe@elitepttc.com
231 421-5805

Shoulder Pain and Dry Needling

This past Friday we thought we’d have a little fun and treat out Shannon’s shoulder pain as part of our weekly in service.  This is a great way for all of us to put our heads together and solve some of our more challenging cases.

Check out the video below to see how we did:

It’s always cool to see significant improvements in range of motion and decreased shoulder pain – especially when the changes are immediate!

There is quite a bit more work to do here to get that shoulder moving right again but dry needling in combination with electrical stimulation can be the kick start that’s needed.

If you’ve been struggling with shoulder pain – and wondering if there is anything that can be done about it – give us a call (231 421-5805).  We’ve been able to help numerous clients with acute and chronic cases of shoulder pain (including those that have had PT elsewhere without success).

Or email questions to Joe@elitepttc.com

If you’re interested – check out the muscles/trigger points with their corresponding referral patterns below:

Rotator Cuff Trigger Points

Teres Minor Trigger Point

Teres Minor Trigger Point

For more information on shoulder pain and trigger points, please refer to a couple previous articles on our blog:

Trigger Points and Shoulder Pain

Trigger Points and Shoulder Pain – Part II

Elite PT March 2018 Newsletter – Curing Headaches and Migraines

Hi Everyone

Hope you’re surviving the prolonged winter.  Luckily spring is right around the corner – I hope!

Kristy and I recently drove out to Appleton, Wisconsin to take an advanced Functional Dry Needling course with Edo Zylstra from Kinetacore.  Edo is one of the top dry needling educators in the United States – THE best in my opinion plus he’s from Michigan so that has to count for something.

Anyway, we learned how to dry needle some of the more difficult to reach muscles plus how to treat more challenging conditions including headaches and migraines.  We’ve been treating headaches and migraines all along but we’ve definitely picked up some new techniques that will only help with more tougher cases.

Unfortunately I didn’t get any cool pictures this time as Kristy and I were too busy sticking needles in one another 10 hours per day.

Headaches/Migraines

Here are some scary stats:

In the U.S., more than 37 million people suffer from migraines. Some migraine studies estimate that 13 percent of adults in the U.S. population have migraines, and 2-3 million migraine suffers are chronic.

Almost 5 million in the U.S. experience at least one migraine attack per month, while more than 11 million people blame migraines for causing moderate to severe disability.

Migraines and headaches can have multiple causes, some of which are not well understood, but one of the most common causes is referred pain from muscles that have attachments to the head and neck.  I personally think this is very often overlooked by medical professionals as its usually easier to just prescribe drugs to cover up the pain.

Check out the pictures below showing some of the main culprits (muscles) and their referral patterns:

Upper Trapezius 
Upper Trapezius Headaches

Suboccipitals

Suboccipital Headaches

Sternocleidomastoid (SCM)
Sternocleidomastoid Headaches

These are all fairly superficial muscles that are easily treated with a number of manual therapy techniques although I do find dry needling works the quickest and the results are longer lasting.  There have been plenty of cases where a client walked in the door with a headache and left without one.

Case 1
This patient was rear ended 3 years ago resulting in severe headaches (9 out of 10 on the pain scale) 2-3x per week.  Chiropractic and physical therapy in the past gave him short term relief of his neck and back pain but didn’t help his headaches.

At the first visit we dry needled the upper trapezius muscles on both sides and over the course of the next week the intensity of his headaches decreased from a 9/10 to 2/10.

Visits 2-4 included the same treatment to the upper traps plus we hit a few of the upper back muscles (not shown above).  The patient reported no headaches at all after the 4th treatment as well as no longer having neck or upper back pain.

Follow up via phone 2 months after the last visit the patient indicated he was still pain free and had no further headaches.

Case 2

This patient had headaches so painful and frequent that she had to have an MRI/CT scan of her head to rule out serious pathology.  Luckily they didn’t find anything but we did find active trigger points in her upper trapezius and suboccipital muscles that referred pain directly into her head (basically the same patterns as you saw in the pictures earlier).

We dry needled her upper trap and suboccipital muscles 3x over a 2 week period.  Over the course of the following two weeks she had one headache that lasted 5 minutes.

Dry needling was performed only once more and following up three weeks later she had remained symptom free.

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These are just two cases recently with very successful outcomes, especially considering the chronic nature of each plus all the other treatments they had been through.

I can’t guarantee that every headache or migraine has a ‘muscular’ cause, but it’s not really that hard to tell during a physical therapy evaluation if that is indeed the case.  We can apply pressure, or just squeeze the muscle, and it will often refer straight to the head.  If that’s the case then that muscle is implicated and needs to be treated.

As you can see in both cases above the results were almost immediate.  One nice thing about dry needling is that is doesn’t take more than a couple sessions to see results.  We can often get good outcomes with other manual techniques as well but in my opinion dry needling usually works the fastest and is longer lasting.

If you’d like to see a quick demo on dry needling, check out the video on our homepage here:  http://www.elitepttc.com/  The subject in the video is actually my dad.  He had intense ‘ram’s horn headaches’ that wrapped around the side of his head – which is typical of the upper trapezius trigger points.

Hope that was some helpful information.  If you suffer from chronic headaches or migraines please contact us with any questions (231 421-5805).

Have a great finish to March!

Joe Heiler PT

Elite PT January Newsletter – Therapist Spotlight: Kristy Ockert

Hi everyone

Hope you had a great Christmas and New Years.

2017 was a great year for us at Elite Physical Therapy and hopefully 2018 will be more of the same.  It’s a blessing for us to be able to work closely with clients like yourself.  We really love getting to know our clients and helping them to achieve their rehabilitation and training goals.  It’s awesome to be able to do something you love for a living, and hopefully it shows!

Free Screening Day

We’ll be hosting another free screening day coming up in February (date to be announced soon).  This is an annual service we’ve started providing to the following:

  • All past physical therapy clients
  • All present clients who have another problem currently not being treated
  • All loved ones, family, friends, neighbors and co-workers of our past and present patients

If you are having pain or problems with day to day activities such as walking, standing, sitting for long periods, going up or down steps, getting in and out of the car, sleeping or driving, then this is an excellent opportunity to see one of our world-class therapists, find out the cause of your problem, and get some treatment ideas.

I’ll be sending out an email soon with more information on how you can take advantage of this free offer.

Therapist Spotlight – Kristy Ockert MSPT

Kristy Ockert began working at Elite Physical Therapy 2 years ago and overall has been practicing since 2002 in the outpatient setting. She earned her Bachelor’s degree in Kinesiology with a specialization in Health Promotion from Michigan State University and her Master of Science in Physical Therapy degree from the University of Colorado Health Sciences Center. Kristy is a Certified Kinesio Taping Practioner (CKTP) and enjoys treating a wide variety of patient populations including post-operative, athletes, and patients with spinal dysfunctions.

She has enjoyed furthering her education with a Pilates specialization and various manual techniques including Graston Technique, Functional Dry Needling, Muscle Energy Technique (MET), Muscle Release Technique (MRT) and Myofascial Release (MFR). Kristy is passionate about providing one on one care to her patients and taking into account all pieces of their individual health puzzle for restoring optimal wellness and return to function.

Q & A:

What got you interested in physical therapy as a career?

It’s a long story!  When I was younger, I wanted to become a teacher, like my mom.  As I got into high school, I knew I wanted to be a doctor – either a pediatrician or sports medicine physician so I could focus on optimizing health for kids and athletes.

My first glimpse of PT was as a patient when I was injured during my high school senior year softball season.  I had a great PT and PTA work with me, but I didn’t think much of it until my senior year of college at MSU.  I decided that I did not want to go to medical school any longer and was looking for a new career path.

After some research and lots of deliberation, I changed my major from Human Biology to Kinesiology, which is the study of human movement.  I finally loved my classes – movement throughout the lifespan, biomechanics, adaptive movement, etc.  It all seemed to fall into place after that.  I got in touch with my former PTA and asked if I could interview her for a class assignment.  It turned into shadowing and weekly volunteering in a small outpatient clinic.  I was hooked!  If I were to become a physical therapist, I could work in the health care field with people of all ages and teach them about how to optimize their movement for improved quality of life.

Over the past couple years you’ve become certified in Graston Technique and dry needling.  Any other techniques you really like to use?

I also enjoy being a Certified Kinesiotaping Practitioner.  Whether it is to help with swelling, bruising, or scar tissue, working on retraining a muscle with proper activation or even unloading an injured area, Kinesiotape has so many uses.

What are your favorite things about being a PT?

I enjoy working with closely with people whether it’s younger athletes, weekend warriors, middle aged or even geriatric patients interested in remaining active.  If there are a few exercises, hands on techniques, and instruction in daily modifications that can make someone’s life more functional and optimize their movement, I’m happy!  I love seeing the changes that people go through from the start to finish of therapy.

Outside of working at Elite, what kinds of things do you and family enjoy?

I enjoy spending time with my husband of 16 years, Ken, and our three kids Carter (14), Peyton (11), and Emma (8).  We love watching movies, going to the beach, bowling and skiing as a family.  I also have a love-hate relationship with winter running, so I’m going to try snowshoeing with my running buddies this year for our longer distances to gear up for the 2018 racing season!

Kristy Ockert
 

 

 

 

 

 

Testimonial

Thank you, thank you, thank you!! After 5 years of physical therapy at numerous other locations, false diagnosis and lack of improvement, MRI’s that showed nothing, Kristy and Lydia correctly diagnosed the problem with my daughters knee and have fixed the problem! You have got her active again with little to no pain. You have brought a smile to her face and to her parents face as well! Thank you for getting her back to healthy! 5 stars isn’t enough! – M.R. Ludington

Sore Knees???
Pain site does not always equal pain source!

Just because your knee hurts doesn’t necessarily mean that the problem lies only with that knee.  You’ve got numerous joints above and below that must move correctly to take the pressure off the knees.

One of the prime examples (or prime offenders) is the ankle joint.  A stiff ankle will negatively affect your walking and running stride, ability to squat down, walk up/down stairs, balance, and more.

The client from the testimonial above was a great example of this.  Resolving her ankle mobility limitations went a long way toward making her knees feel better.

Check our the link below for a short article/video on how we assess and solve the problem of ankle mobility:  http://www.elitepttc.com/ankle-mobility-update/

This is exactly the kind of thing our free screening day is for!

Til next month

Joe Heiler PT

Hip Flexor/Ankle Dorsiflexion March

Elite PT June 2017 Newsletter – Dry Needling for Ankle and Foot Pain, Athlete Updates, and more…

Welcome to this month’s issue of the Elite Physical Therapy and Sports Performance newsletter.  Check out the short article and demo videos on dry needling, see what some of our graduating athletes will be up to in the Fall, as well as our ‘Exercise Tip of the Month’:

I can’t believe it’s already June and school’s just about out!

Here’s what’s new at Elite Physical Therapy this month:


Kristy Ockert MSPT just completed her first Functional Dry Needling course down at Grand Valley State University a few weeks ago.  She had a great time and learned some cool new techniques.  Since then she’s been practicing on Lydia and myself to fine tune her skills.  Follow the link below to see how its going!

We’ve seen numerous clients lately with calf pain, Achilles tendonitis, and plantarfasciits who’ve had great results with the combination of dry needling, Graston Technique, and exercise.  Here is what one of our clients with Achilles tendonitis had to say:

“I had issues walking at work and limited mobility in the ankle before therapy.  I can now walk all day at work and have no pain or swelling in the ankle area.” – K.W. from Grayling

In this case, PT was the last option prior to surgery.  Thankfully we were able to avoid surgery and get her back to work without pain.

There are certainly plenty more conditions that can benefit from dry needling in addition to the other physical therapy techniques that we employ.  Relieving pain and improving muscle function are big benefits of this technique.  To see more on dry needling, how it works, and a demonstration for treating neck pain and headaches, click the link HERE to check out the video on our home page.

If you have any questions about the technique or if you’re wondering if dry needling may work for you, feel free to give us a call at 231 421-5805.  Ask for Joe or Kristy.
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Athlete News

I want to acknowledge some of our past and present clients that will be moving on at the end of this school year to further pursue their athletic dreams.  These guys are a hard working bunch and will be missed!

Chris Kolarevic from St. Francis High School – will be playing football at the University of Northern Iowa.
Michael Hegewald from St. Francis High School – will be playing football at the University of Dayton.
Alec Trautman from Elk Rapids High School – will be playing football at the University of Dayton.
Will Russell from Traverse City East Middle School – will be attending the Steamboat Mountain School in Colorado skiing on their U16 Alpine Team.

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Exercise Tip of the Month

We’ve been talking about treatments for the lower leg and foot the past couple months so I thought I’d stick with this commonly injured area one more time.  Last month I showed a great way to improve the way the foot and ankle move – if you missed it just let me know and I can re-send that to you.  This month we’ll look at an easy way to begin strengthening.

Ankle Marching with mini-band

Place the band around your feet with the feet just wide enough that there is a small amount of tension on the band.  Bring the knees up toward your chest and flex the ankles back as far as possible.  Kick one leg out straight but keep the opposite leg motionless.

Hip Flexor/Ankle Dorsiflexion March

Hip Flexor/Ankle Dorsiflexion March – Start Position

 

Hip Flexor/Ankle Dorsiflexion March

Hip Flexor/Ankle Dorsiflexion March – Finish Position

The leg that remains motionless will actually be the leg that is working the hardest.  Do not let this leg follow the other!  Not only will you feel the muscles in the front of the lower leg working hard but you’ll also feel your hip and stomach muscles.  This exercise is typically done after stretching out the calf muscles and is done for 2 sets of 10 on each side.
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Have a great month and talk to you again in July!

Joe Heiler PT

 

 

Back Pain and Sciatica – Part 2

Last month I posted a case study showing how we treat back pain and associated ‘sciatica’ like symptoms here at Elite Physical Therapy in Traverse City.  You can find that article here:  http://www.elitepttc.com/back-pain-and-sciatica-physical-therapy-treatments/

This month’s case study is a little different in that the presentation and location of the pain were quite different but it still comes down to playing detective to determine where the patient’s symptoms are really coming from.  Before we get started here, I’m re-posting the picture of the dermatomes of the body (basically the sensory distribution of the nerves from the spine) so be sure to check that out.  Pretty cool how we were created for sure!Dermatomes

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with Graston Technique (GT) to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and GT.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

A little detective work plus effective treatment tools like dry needling and Graston Technique can make a huge difference in patient outcomes especially in these ‘sciatica’ cases.  If you have similar types of symptoms or pain that just doesn’t ever seem to get better then give us a call!  If you have any questions feel free to email me:  joe@elitepttc.com

Back Pain and Sciatica – Physical Therapy Treatments

This month I figured I’d post on a couple case studies related to back pain and sciatica, and how we evaluate and treat cases like this at Elite Physical Therapy.  We’ve had a lot of great success with these folks so thought I’d share a couple examples.

Back pain, and associated leg pain, can be difficult to treat but we like a challenge!  Playing detective can be fun if you know what to look for.  Check out the pictures below that show the paths the spinal nerves take throughout the body.  Leg pain (or what many people like to call ‘sciatica’) can follow a number of paths down the leg and sometimes that can be a dead give away to identify exactly where the pain is coming from.

dermatomes

***The letter and numbers above correspond to a particular spinal nerve, i.e. L4 means lumbar spinal nerve #4 ***

There are other ways to narrow down the location of the problem as well:

  • the muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve #4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So here’s a great example of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Pretty simple exercises that are beyond the scope of this article but lots of bang for your buck when they only take 5 minutes 2-3 x per day.

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Final Thoughts

Sometimes it just works that well but I certainly won’t make that guarantee in every case!  Back pain and ‘sciatica’ cases can be quite complex but knowing how to put together all the puzzle pieces definitely helps.

That’s probably enough to wrap your head around for this time.  Next month I’ll post another case study but with a different symptom presentation.  In the meantime if you have any questions just shoot me an email:  joe@elitepttc.com or call 231 421-5805.

Dry Needling for Hip and Knee Pain

At Elite Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling has been one on my go-to treatments for the past 3 years now, and the method I’m going to show you today works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus Lateralis Trigger Points

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created for my SportsRehabExpert.com website which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using Graston Technique and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at Elite Physical Therapy and Sports Performance.

Big thanks to our Athletic Trainer, Lydia Case, for being our ‘patient’!

Trigger Points and Shoulder Pain – Part II

originally posted on SportsRehabExpert.com

Joe Heiler PT

Shoulder pain is such a common diagnosis that we’ll see here at Elite Physical Therapy, and there are a number of structures that can be pain generators to the shoulder and arm. Last month I talked about trigger points in the posterior rotator cuff (Infraspinatous and Teres Minor) along with their common referral patterns. Another common shoulder muscle to find active trigger points is the supraspinatous. Active trigger points in this muscles can refer pain to the deltoid and down the lateral aspect of the arm.

Check out the typical trigger points and referral patterns below:

Supraspinatous Trigger Point Referral

Check out the video below for a demonstration of dry needling to the supraspinatous:

Case study:

Feel free to check out this case study but it was originally written for physical therapists and chiropractors. Ultimately the point is that a combination of dry needling and soft tissue mobilization, in addition to corrective exercises, can significantly decrease pain while improving range of motion and movement.

Current patient of mine presents with lateral arm pain of 3 months duration. No known cause of injury but diagnosed with tricep injury/tear.

Pre-Treatment

SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)
  • R shoulder medial rotation extension (mobility) – FN to the L
  • MS rotation R (motor control deficit) – FN to the L.

    SFMA dysfunctional painful patterns:

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    Special tests:

  • Hawkins + on the R
  • Passive shoulder IR 20 deg.

    Palpation:

  • Tenderness with palpation of both trigger point in the supraspinatous with referral of pain down the lateral upper extremity to the wrist (indicates that is the pain he gets into the upper arm)

    Treatment on Day 1 consisted of Functional Dry Needling to the supraspinatous (x2) with electrical stimulation followed by more superficial Graston technique to the R upper trap, supraspinatous, infraspinatous, and teres minor along with light strumming at the supraspinatous insertion. Corrective exercise included 3pt. thoracic rotation (UE positioned in internal rotation – hand behind the back) with manual assist to hold/relax work until pt. was able to control the full available range.

    Post-Treatment

    Functional Non-Painful patterns:

  • R shoulder medial rotation extension
  • MS rotation B

    SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)

    SFMA dysfunctional painful patterns :

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    ***both are still painful although intensity has decreased while motion has increased***

    Special tests:

  • Hawkins + on the R but much less intense
  • Passive shoulder IR 50 deg.
  • Graston Technique – Treating the Painful Shoulder

    Here is the video I promised using Graston Technique to treat soft tissue dysfunction in the posterior shoulder girdle using and in particular the trigger points that can refer pain to the front of the shoulder and down the arm.

    If you haven’t read the previous article discussing why we would want to treat this area, you can check that out here:  http://www.elitepttc.com/blog/trigger-points-and-shoulder-pain/

    If you have any questions concerning Graston Technique, Dry Needling, or shoulder pain please contact us at 231 421-5805 or Joe@elitepttc.com