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Trigger Point Dry Needling E-Book

Trigger Point Dry Needling E-Book

Jan Dommerholt | Cesar Fernandez de las Penas


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Book Details


Since the publication of the first edition in 2013, the utilization of dry needling in clinical practice has expanded dramatically throughout the world. Indeed, more and more professionals have been using dry needling to effectively reducing acute and chronic pain, as well as improving motor performance, range of motion, and strength.

Following the success of the previous edition, the updated Trigger Point Dry Needling: An Evidence and Clinical-Based Approach remains the first authoritative guide on the market.

With a completely revised text and now full colour illustrations, it provides excellent clarity within content and images for even more uniform and consistent instructions on the needling techniques.

Written and edited by a group of international experts, this is the most-up-to-date resource for physiotherapists, chiropractors, myotherapists, and other professionals as physicians, acupuncturists, osteopaths and athletic trainers.

  • New chapters on the use of dry needling for Neurological Conditions and dry needling for Fascia, Scar, and Tendon;
  • Clinical chapters with new full colour illustrations;
  • Worldwide editors and contributors;
  • New chapters on the use of dry needling for Neurological Conditions and dry needling for Fascia, Scar, and Tendon;
  • Clinical chapters with new full colour illustrations;
  • Worldwide editors and contributors;

Table of Contents

Section Title Page Action Price
Front Cover Cover
Trigger Point Dry Needling: An Evidence and Clinical-Based Approach iii
Copyright iv
Contents v
Preface xi
Acknowledgements xiii
Dedication xiii
Contributors xv
Part 1: Basis of trigger point dry needling 1
Chapter 1 Basic Concepts of Myofascial Trigger Points 1
Myofascial trigger point overview 1
Neurophysiological basis of muscle referred pain 2
Clinical Characteristics of Muscle Referred Pain 2
Mechanisms and Neurophysiological Models of Referred Pain 2
Convergent-projection theory 3
Convergence-facilitation theory 3
Axon-reflex theory 3
Thalamic-convergence theory 3
Central hyperexcitability theory 3
Neurophysiological aspects of myofascial trigger points 4
The Nature of Trigger Points 4
Taut bands 4
The motor endplate 4
Local twitch response 6
Muscle pain 6
Sensitisation Mechanisms of Trigger Points 7
Trigger point as a focus of peripheral sensitisation 7
Trigger point nociception induces central sensitisation 8
Muscle referred pain is a process of reversible central sensitisation 9
Sympathetic facilitation of local and referred muscle pain 9
Pathophysiology of Trigger Points: The Integrated Hypothesis 10
Other Hypothetical Models 11
References 12
Chapter 2 Proposed Mechanisms and Effects of Trigger Point Dry Needling 21
Introduction 21
Mechanisms and effects of trigger point dry needling 22
Summary 25
References 25
Chapter 3 Dry Needling for Fascia, Scar, and Tendon 31
Introduction 31
Fascia and scar dry needling 31
Introduction to Fascia 31
Sensory Aspects of Fascia 32
Biomechanical Aspects of Fascia 32
Dry Needling of Fascia 33
Dry Needling of Scar Tissue Adhesions 34
Dry needling and tendon 34
Clinical Reasoning for Tendon Needling 34
Needling Therapies for Tendons 35
Clinical Guidelines for Tendon Dry Needling 35
Mechanisms of Dry Needling for the Tendon 37
References 37
Chapter 4 Dry Needling for Neurological Conditions 43
Introduction 43
Spasticity and muscle tone 43
Pain in neurological conditions 44
Botulinum toxin a for spasticity and related pain 44
Dry needling for neurological conditions 45
Clinical reasoning for dry needling in neurological conditions 46
Clinical guidelines for dry needling in spasticity 47
Diagnostic Clinical Decision 47
Dry Needling Procedure 47
Mechanisms of dry needling on neurological conditions 48
Clinical considerations 49
References 50
Chapter 5 Trigger Point Dry Needling: Safety Guidelines 55
Introduction 55
Trigger point dry needling: safety 55
Hygiene 58
Hand Hygiene 58
Handwashing with soap 58
Hand decontamination with alcohol-based hand rub 59
Gloves 59
Patient Skin Preparation 60
Needle and Medical Waste Disposal 60
Needlestick Injury 60
Contraindications and precautions 61
Absolute Contraindications 61
Relative Contraindications 61
Abnormal bleeding tendency 61
Compromised immune system 61
Vascular disease 61
Diabetes 61
Pregnancy 62
Children 62
Frail patients 62
Patients with epilepsy 62
Psychological status 62
Patient allergies 62
Patient medication 62
Unsuitable patient for any reason 62
Anatomical considerations 62
Pleura and lung 63
Blood vessels 63
Nerves 63
Organs 63
Joints 63
Prosthetic implants 63
Implanted devices 63
Other 64
Procedural safety issues 64
Painful treatment 64
Bruising and bleeding 64
Fainting and autonomic responses 64
Needle issues 64
Forgotten patient 65
Infection 65
Pneumothorax 65
Drowsiness and fatigue 65
General guidelines for principles of practice 65
Patient selection 66
Principles of dry needling application 67
Patient Education and Consent 67
Procedural Education 67
Practical Application 67
Positioning 67
Palpation 68
Technique 68
Aftercare 69
Electrical stimulation via dry needles 69
Summary 70
Acknowledgement 70
References 70
Chapter 6 Dry Needling Across Different Disciplines 73
Introduction: scope of practice 73
Dry needling by multiple disciplines 73
Medicine 74
Veterinary Medicine 74
Dental Medicine 74
Physical Therapy/Chiropractic/Myotherapy 75
Acupuncture 75
Opposition to dry needling by nonacupuncturists 75
Summary 76
References 76
Part 2: Clinical and evidence-informed approach of TrP dry needling 79
Chapter 7 Deep Dry Needling of the Head and Neck Muscles 79
Introduction 79
Clinical presentation of trigger points in head and neck pain syndromes 80
Trigger Points in Headache and Orofacial Pain Populations 80
Myofascial trigger points in temporomandibular pain 80
Myofascial trigger points in tension-type headache 81
Myofascial trigger points in migraine headache 83
Myofascial trigger points in other headaches 84
Trigger Points in Neck Pain Populations 84
Dry needling of head muscles 86
Corrugator Supercilii Muscle 86
Procerus Muscle 86
Masseter Muscle 87
Temporalis Muscle 87
Zygomatic Muscle 88
Buccinator and Risorius Muscles 88
Superior Pharyngeal Constrictor Muscle 89
Medial Pterygoid Muscle 89
Lateral Pterygoid Muscle 90
Digastric Muscles 91
Dry needling of neck–shoulder muscles 92
Trapezius Muscle: Upper Portion 92
Levator Scapulae Muscle 92
Sternocleidomastoid Muscle 93
Splenius Capitis Muscle 94
Splenius Cervicis Muscle 95
Semispinalis Capitis and Cervicis Muscles 95
Cervical Multifidi Muscles 96
Suboccipital Muscles 96
Scalene Muscles 96
Longus Colli Muscle 98
References 98
Chapter 8 Deep Dry Needling of the Shoulder Muscles 105
Introduction 105
Clinical relevance of myofascial trigger points in shoulder pain syndromes 105
Shoulder Pain and Movement Dysfunction 106
Trigger Points and Range of Motion Restrictions 107
Trigger Points and Stability 107
Dry needling of the shoulder muscles 107
Supraspinatus Muscle 107
Infraspinatus Muscle 107
Teres Minor Muscle 108
Subscapularis Muscle 108
Deltoid Muscle 109
Teres Major Muscle 110
Pectoralis Minor Muscle 111
Pectoralis Major Muscle 111
Subclavius Muscle 113
References 114
Chatper 9 Deep Dry Needling of the Arm and Hand Muscles 117
Introduction 117
Clinical relevance of trigger points in arm and hand pain syndromes 117
Dry needling of the arm and hand muscles 118
Coracobrachialis Muscle 118
Biceps Brachii Muscle 119
Triceps Brachii Muscle 120
Anconeus Muscle 120
Brachialis Muscle 121
Brachioradialis Muscle 121
Supinator Muscle 122
Wrist and Finger Extensor Muscles 122
Pronator Teres Muscle 124
Wrist and Finger Flexor Muscles 124
Extensor Pollicis Longus and Brevis and Abductor Pollicis Longus Muscles 125
Extensor Indicis Muscle 126
The Thenar Muscles 127
Interosseous and Lumbrical Muscles 127
The Hypothenar Muscles 129
References 130
Chapter 10 Deep Dry Needling of the Trunk Muscles 133
Introduction 133
Clinical relevance of trigger points in syndromes related to the trunk 134
Dry needling of the trunk muscles 136
Rhomboid Major and Minor Muscles 136
Serratus Posterior Superior Muscle 137
Middle Trapezius Muscle 138
Lower Trapezius Muscle 139
Latissimus Dorsi Muscle 140
Serratus Anterior Muscle 142
Longissimus Thoracis Muscle 143
Iliocostalis Thoracis and Lumborum Muscles 144
Thoracic and Lumbar Multifidus Muscles 145
Serratus Posterior Inferior Muscle 146
Quadratus Lumborum Muscle 146
Psoas Major Muscle 147
Rectus Abdominus Muscle 148
Pyramidalis Muscle 149
External and Internal Oblique Abdominal Muscles 150
References 151
Chapter 11 Deep Dry Needling of the Hip and Pelvic Muscles 155
Introduction 155
Clinical relevance of trigger points in syndromes related to the pelvis 156
Clinical relevance of trigger points in syndromes related to the hip and thigh 157
Dry needling of the abdominal, hip, pelvis, and thigh muscles 158
Hip Muscles 158
Gluteus maximus muscle 158
Gluteus medius muscle 158
Gluteus minimus muscle 159
Tensor fascia latae muscle 160
Iliacus muscle 160
Obturator internus muscle 161
Obturator externus/gemellus inferior and superior muscles 162
Quadratus femoris muscle 162
Piriformis muscle 164
Pelvic Diaphragm Muscles 164
Ischiocavernosus muscle 164
Bulbospongiosus (bulbocavernosus) muscle 165
Superficial and deep transverse perinei muscles 166
Pubococcygeus muscle of the pelvic diaphragm 166
Iliococcygeus muscle of the pelvic diaphragm 167
Coccygeus muscle of the pelvic diaphragm 167
Thigh Muscles 168
Adductor longus muscle 168
Adductor brevis muscle 168
Adductor magnus muscle 169
Pectineus muscle 169
Gracilis muscle 170
Rectus femoris muscle 170
Vastus lateralis muscle 171
Vastus medialis muscle 171
Vastus intermedius muscle 171
Genu articularis muscle 172
Biceps femoris muscle 172
Semimembranosus and semitendinosis muscles 173
Sartorius muscle 173
References 174
Chapter 12 Deep Dry Needling of the Leg and Foot Muscles 179
Introduction 179
Clinical relevance of trigger points in leg and foot pain syndromes 179
Dry needling of the leg and foot muscles 182
Popliteus Muscle 182
Gastrocnemius Muscle 182
Plantaris Muscle 184
Soleus Muscle 184
Flexor Digitorum Longus Muscle 185
Tibialis Posterior Muscle 185
Flexor Hallucis Longus Muscle 186
Fibularis Longus and Brevis Muscles 186
Fibularis Tertius Muscle 187
Tibialis Anterior Muscle 187
Extensor Digitorum Longus Muscle 187
Extensor Hallucis Longus Muscle 188
Extensor Digitorum Brevis and Extensor Hallucis Brevis Muscles 188
Abductor Hallucis Muscle 189
Abductor Digiti Minimi Muscle 189
Flexor Digitorum Brevis Muscle 190
Quadratus Plantaris/Flexor Accessorius Muscle 191
Flexor Hallucis Brevis Muscle 191
Adductor Hallucis Muscle 192
Dorsal and Plantar Interossei Muscles 193
References 193
Part 3: Other dry needling approaches 197
Chapter 13 Superficial Dry Needling 197
Introduction 197
Superficial dry needling 197
Variable reactivity to needle-evoked nerve stimulation 197
Procedure recommended for the carrying out of superficial dry needling 198
The initial consultation 198
Systematic search for trigger points 198
Muscle stretching exercises 198
Measures to be taken to prevent trigger point reactivation 198
Postural Disorders 198
Management of Stress 199
Biochemical Disorders 199
Summary 199
References 199
Chapter 14 Dry Needling from a Western Medical Acupuncture Perspective 201
Introduction and historical development 201
Dry Needling—A Historical Perspective 201
Traditional Acupuncture 201
Western Medical Acupuncture 202
Neurophysiological mechanisms of the technique 202
Neurophysiology of Acupuncture Needling 202
Local effects 202
Segmental effects 203
Heterosegmental effects 203
General effects 203
Trigger Point Needling 204
Clinical research 204
Methodological Difficulties of Clinical Acupuncture Research 204
Evidence for Acupuncture Needling in Chronic Pain Conditions 205
Chronic low back pain 205
Chronic headache 205
Osteoarthritis 205
Shoulder pain 206
Evidence for Needling in Myofascial Pain 206
Clinical application of the technique 206
Safety Aspects 206
Point Selection 207
Needle Technique 207
Clinical Aspects 229
Prognosis 230
Summary 230
References 230
Chapter 15 Intramuscular Stimulation 235
Introduction 235
Neurophysiological mechanism of gunn intramuscular stimulation 237
Clinical application of gunn intramuscular stimulation 242
Introduction 242
Patient History and Past Treatment 243
Physical Assessment 244
Sensory findings 244
Motor Findings 244
Observation 244
Range of motion 244
Palpable Bands 244
Autonomic Findings 244
Vasomotor Disturbances 244
Sudomotor Reflex 244
Pilomotor Reflex 245
Trophic Changes 245
Trophic Oedema 245
Treatment 246
Number of Treatments 248
Duration of Session 248
Needle Insertion 248
Needle-Grasp 248
Concurrent Treatments 249
Reassessment 250
The Tools of Gunn Intramuscular Stimulation 250
Needle/Sizes 250
Plunger 250
Cleaning and Sterilisation 251
Case study example 251
References 251
Chapter 16 Fu’s Subcutaneous Needling 255
Concept and Terminology 255
Origin of fu’s subcutaneous needling 257
Contemplation of De-Qi 257
Clinical Application of Wrist–Ankle Acupuncture 257
Ancient Techniques 257
Development of fu’s subcutaneous needling 259
Innovation of the Fu’s Subcutaneous Needling Needle 259
Increase of Fu’s Subcutaneous Needling Indications 259
Stage 1: Fu’s subcutaneous needling was mainly used to treat patients with soft tissue injuries of the extremities 259
Stage 2: Fu’s subcutaneous needling was used to treat patients with nonvisceral diseases in the trunk 260
Stage 3: Fu’s subcutaneous needling was used to treat patients with benign painful visceral problems 260
Stage 4: Fu’s subcutaneous needling was used to handle painful problems in the head and face and nonpainful diseases 260
Fu’s subcutaneous needling manipulations 260
Structure of the Fu’s Subcutaneous Needling Needle 260
Preparation Before Treatment 261
Select a treatment posture 261
Palpate the tightened muscles 261
Locate the insertion area 262
Sterilise 262
Needling Method 262
Needle insertion 262
Swaying movement 264
Reperfusion technique 264
Reperfusion approach for the neck area 267
Reperfusion approach for the shoulder 267
Usual reperfusion approach for back pain 267
Usual reperfusion approach for knee pain 267
Retention 267
Precautions, contraindications, and management of side effects 270
Factors that influence fu’s subcutaneous needling effects 271
Main Factors That Influence Short-Term Effects 271
Factors That Influence Long-Term Effects 271
Fu’s subcutaneous needling features 272
Manipulation Features 272
The selection of the Fu’s subcutaneous needling insertion area is based on the nature of tightened muscles or other focal d ... 272
The Fu’s subcutaneous needling needle is inserted into nondiseased areas 272
The insertion of Fu’s subcutaneous needling needle is restricted to the subcutaneous tissue 272
De-Qi is not required during Fu’s subcutaneous needling treatment 272
The Fu’s subcutaneous needling needle is retained in the subcutaneous tissues for a prolonged period of time 272
The tip of Fu’s subcutaneous needling needle is directed to the painful region 273
The Fu’s subcutaneous needling needle is swayed from side to side 273
The involved muscles and joints can move easily during Fu’s subcutaneous needling treatment 273
Characteristics of Effectiveness 273
Acknowledgement 273
References 273
Index 277