With my 20th PT Class Reunion coming up this year, I've been feeling a little nostalgic—reflecting on the good old days of Gross Anatomy lab, the camaraderie with classmates, and an abundance of time dedicated to establishing a foundation in physical therapy. One of the fundamentals we learned, of course, was how to assess correct posture. We had plumb lines that ran from the ceiling, memorized the four postural types as described by Florence Kendall, and recorded them on our worksheets.
Abstract of The Week: Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies by Larissa T. Baselgia, MSca, David L. Bennett, PhDb, Robert M. Silbiger, MScc, and Annina B. Schmid, PhDb.
Admittedly, we didn't have to search too hard to find this particular Abstract of the Week, as its authors include NAIOMT faculty. Thus, it goes without saying that we find this an important topic to research, read about and discuss.
Alright, this week's abstract isn't your average study. And while I know that an "N" of one does not hold a lot of statistical power, I still think this one warrants a quick read. Why? Let me tell you.
Objective: To investigate the relationship between dry needling-induced twitch response and change in pain, disability, nociceptive sensitivity,and lumbar multifidus muscle function, in patients with low back pain (LBP).
Design: Quasi-experimental study.Setting Department of Defense Academic Institution.
Participants: Sixty-six patients with mechanical LBP (38 men, 28 women, age: 41.3 [9.2] years).
Interventions: Dry needling treatment to the lumbar multifidus muscles between L3 and L5 bilaterally.
Main outcome measure:s Examination procedures included numeric pain rating, the Modified Oswestry Disability Index, pressure algometry,and real-time ultrasound imaging assessment of lumbar multifidus muscle function before and after dry needling treatment. Pain pressurethreshold (PPT) was used to measure nocioceptive sensitivity. The percent change in muscle thickness from rest to contraction was calculatedto represent muscle function. Participants were dichotomized and compared based on whether or not they experienced at least one twitchresponse on the most painful side and spinal level during dry needling.
Result:s Participants experiencing local twitch response during dry needling exhibited greater immediate improvement in lumbar multifidusmuscle function than participants who did not experience a twitch (thickness change with twitch: 12.4 %, thickness change without twitch:5.7 %, mean difference adjusted for baseline value, 95%CI: 4.4 [1 to 8]%). However, this difference was not present after 1-week, andthere were no between-groups differences in disability, pain intensity, or nociceptive sensitivity.
Conclusions: The twitch response during dry needling might be clinically relevant, but should not be considered necessary for successfultreatment.
To pop, or not to pop? That has long been a questions among clinicians who utilize spinal manipulation. Is the cavitation, or audible pop, necessary to achieve a "successful" manipluation? While some literature indicates that it may not be necessary, this remains a viable question.
In an almost synonymous fashion, achieving a local twitch response (LTR) has been viewed by some as one of the primary goals with dry needling as it has been associated with better treatment outcomes (1,2). The local twitch response has been shown to be associated with a decrease in nociceptive and inflammatory chemicals (1,3-6), increased blood flow (7), and decrease pain (8) to name a few. In some circles, the LTR considered as the hallmark of a successful dry needling treatment. Recently, the authors sought to investigate the association between the LTR and changes in pain and function in patients with lumbar pain.
**Abstract of the week shared by NAIOMT Clinical Fellowship Instructor Gary Kearns, PT, COMT, FAAOMPT
2. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger points. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256-263.
3. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439-444.
4. Huguenin LK. Myofascial trigger points: the current evidence. Phys Ther Sport. 2004;5(1).
5. Shah JP, Phillips T, Danoff JV, Gerber LH. A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active. Arch Phys Med Rehabil. 2003;84(9):E4.
6. Shat JP, Phillips TM, Danoff, JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J App Physiol. 2005;99(5):1977-1984.
7. Jimbo S, Atsuta Y, Kobayashi T, Matsuno T. Effects of dry needling at tender points for neck pain (Japanese: Katakori): near-infrared spectroscopy for monitoring muscular oxygenation of the trapezius. J Orthop Sci. 2008;13(2):101-106.