I was doing some research on Internet about the swelling I see in certain groups of muscles.  I know it is there, I can see it , palpate it and work on it to relieve it.  Just needed to describe it.  Here is an interesting way to look at the cause.

Treating and Preventing DOMSJohndavid Maes, and Len Kravitz, Ph.D. Articles Reviewed: Connolly, D.A.J., S.P Sayers, and M.P. McHugh. Treatment and prevention of delayed onset muscle soreness. J. Strength Cond. Res. 17(1):197-298. 2003. Szymanski, D.J. Recommendations for the avoidance of delayed-onset muscle soreness. J. Strength Cond. Res. 23(4): 7-13. 2001.  In their review, Connolly et al. (2003) explain that the injury itself is a result of eccentric exercise, causing damage to the muscle cell membrane, which sets off an inflammatory response. This inflammatory response leads to the formation of metabolic waste products, which act as a chemical stimulus to the nerve endings that directly cause a sensation of pain. These metabolic waste products also increase vascular permeability and attract neutrophils (a type of white blood cell) to the site of injury. Once at the site of injury, neutrophils generate free radicals (molecules with unshared electrons), which can further damage the cell membrane. Swelling is also a common occurrence at the site of membrane injury, and can lead to additional sensations of pain. Connolly et al. also note the importance of differentiating DOMS from other injuries such as muscle strains. This difference is important to appreciate because when muscle strain is sustained from vigorous exercise, particularly eccentric exercise, it can severely worsen the injury. In contrast, in a muscle that is experiencing DOMS, continued eccentric exercise is still possible without further muscle damage. When dealing with DOMS it is important to differentiate it from muscle strains, recognizing that continued exercise is still possible with DOMS, but not with muscle strain.

Dry Needling in Kentucky

Sorry it has been so long since I have posted.  We have been in the process of remodeling our clinic and working on getting line up to be able to most effectively work with our patients and clients.  

I did want to mention that Dry Needling is somewhat new to Kentucky.  There are a few PTs in Louisville that are using Dry Needling but as of right now, I don't think there are any in Lexington.  I invite you to search the Internet for information on Dry Needling and possibly decide that it may be something that will help you.  Below is an article from Advance Magazine that discusses Dry Needling. I realize it may be long but it is a good read  

Points of Clarification

Delineating the distinction between acupuncture and dry needling for trigger-point pain

By Dimitrios Kostopoulos, PT, MD, PhD, DSc, ECS, and Konstantine Rizopoulos, PT, DPT, MCMT

Posted on: October 15, 2012

View Comments (0)Print ArticleEmail Article

Share

Vol. 23 • Issue 21 • Page 29 Trigger Point Pain Myofascial trigger-point pain is a prevalent condition facing therapists who treat chronic pain cases. Myofascial trigger-point therapy has become widely used by many healthcare providers for a variety of musculoskeletal problems. Several studies demonstrate a high prevalence of pain due to myofascial trigger points. One researcher suggests that prevalence of pain originating from myofascial trigger points in a general pain practice can reach the level of 85 percent. The recognition of the myofascial pain phenomenon by the medical community as one of the key pain generators has led to the development and expansion of a variety of myofascial therapy interventions. Two instrument-assisted means of treating chronic pain conditions are acupuncture and trigger-point dry needling. Unfortunately, many therapists confuse the terms acupuncture and dry needling, or use the terms interchangeably. However, a clear and definitive distinction exists between the two modalities, and a distinction must be made to avoid confusion. Dry Needling Trigger-point dry needling is one of many treatment methods for myofascial trigger points and it is not proprietary to one specific profession. Trigger-point dry needling is practiced around the world by physicians, physical therapists, acupuncturists, chiropractors, osteopaths, dentists, nurses and many other properly trained healthcare providers who specialize in the treatment of myofascial trigger points. Dry needling is the insertion and repetitive manipulation of a fine, flexible, filamentous needle within a myofascial trigger-point area that produces repetitive local twitch responses and leads to inactivation of the trigger point or a decrease of the trigger-point activity. Preliminary research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation. It's unfortunate that a number of acupuncture practitioners and some of their associations try to equate dry needling with acupuncture, and to make dry needling proprietary to acupuncturists. Some do this by using a modified definition of acupuncture points, which defines an acupuncture point the same as a myofascial trigger point. This creates confusion regarding appropriateness of treatment, which may have negative consequences on consumers deciding on the most appropriate provider for their condition. Belgrade supports that "tender points are acupuncture points and can be often chosen for therapy."1-3 Belgrade uses one of the major criteria used to define a trigger point to also define an acupuncture point. Issues become even more confusing when one considers that trigger-point dry needling,4-6 one of the major treatments for myofascial trigger points, is performed with an acupuncture needle. Acupuncture Acupuncture is a traditional system of Chinese medicine that has been practiced for more than 2000 years.7The Florida State Code defines acupuncture as follows: "Acupuncture" means a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance and restoration of health and the prevention of disease. Acupuncture shall include, but not be limited to, the insertion of acupuncture needles and the application of moxibustion to specific areas of the human body and the use of electroacupuncture, Qi gong, Oriental massage, herbal therapy, dietary guidelines and other adjunctive therapies as defined by board rule. In some manner, the ancient Chinese became aware of certain sensitive skin areas (sensitive points) when a body organ, muscle or function was impaired. They also observed that these sensitive skin areas were the same or similar in all people who suffered from the same impairment. Moreover, the sensitive areas varied consistently according to the organ or muscle function deviating from the norm. It was at this point that some of the relationships among various internal organs or muscles and their functions were observed and established.7-9 Acupuncture was introduced to the West in the 17th century by Jesuit missionaries sent to Peking. In the 1940s, French sinologist and diplomat Soulie de Morant published his voluminous writings on acupuncture.8 Acupuncture was first introduced in the United States in the late 1960s. Since then, Western licensed acupuncturists use acupuncture primarily for the treatment of various conditions such as gastrointestinal problems, gynecological conditions, infertility, musculoskeletal problems, immunological conditions, smoking cessation and many others. Melzack et al found a 71-percent correlation between trigger points and acupuncture points for the treatment of pain.10 Melzack's contention was that trigger points and acupuncture points may have the same neural mechanism. However, new discoveries clearly demonstrate that the trigger-point phenomena originate in the vicinity of dysfunctional endplates,11-12 and this puts an end to the previous claim by Melzack. In a subsequent article, Melzack defines acupuncture and trigger-point dry needling as two distinctively different approaches.13 Recognizing the Distinction Despite some similarities in terms of location between acupuncture points and trigger points, the objective clinician and researcher must recognize the distinct differences. These differences define acupuncture points and trigger points as two completely different clinical entities with possible overlaps.5-14 There are foundational and pathophysiological differences between trigger points and acupuncture points. Classical acupuncture points are identified as precise points along meridians defined by ancient Chinese documents.9 An exception to that are extrameridian and "achi" points. Conversely, myofascial trigger points may be found anywhere within a muscle belly, and there is evidence that their pathophysiological mechanism resides in dysfunctional endplates.12,15 Trigger-point dry needling is a very effective clinical intervention for the treatment of myofascial pain syndrome. While this intervention uses a thin filamentous stainless steel needle, the same as an acupuncture needle, it is distinctly different from acupuncture both in the rationale and its means of application.5-14It is important to understand that these two approaches are very different and require different training for their clinical application. Trigger-point dry needling is not proprietary to one specific profession, but can be practiced by properly trained healthcare providers. Scientific merit requires that we are clear in our distinction between these two separate treatment approaches. References are available at www.advanceweb.com/pt under the Resources tab. Dimitrios Kostopoulos graduated from the New York College of Traditional Chinese Medicine and UHSA School of Medicine. He can be reached at dimi@handsonpt.org. Konstantine Rizopoulos is a graduate of Evidence in Motion's DPT program. He can be reached at kostas@handsonpt.org They are founders of Hands-On Seminars (www.handsonseminars.com) and Hands-On Care Physical Therapy in New York. Therapist, Heal Thyself The concept for a soft-tissue therapy device evolved over the past 25 years treating patients with every condition from carpal tunnel syndrome to low-back pain to plantar fasciitis and more. About seven years ago, I found myself in the middle of battling carpel tunnel syndrome and osteoarthritis in both of my hands, wrists and forearms from the years of practicing soft-tissue therapy without using any professional quality instruments. I searched for a tool that could facilitate my manual therapy techniques and that would ultimately help me get better results for my patients. Finding none, I knew I had to create something myself that would help me continue practicing all of those soft-tissue therapy techniques while simultaneously protecting and rehabilitating myself. The bene?ts of the soft-tissue therapy tool are numerous for both the patient and the therapist. Every millimeter is designed to be in contact with the human body either as a treatment surface, handle/grip or both. The device is very capable at implementing a wide variety of orthopedic and manual soft-tissue therapy treatments, techniques and conditions. These include but are not limited to IT band syndrome, rotator cuff injuries, nerve entrapment, osteoarthritis, psoas release, TMJ, tennis elbow and carpel tunnel syndrome. Clinicians can implement almost any soft-tissue therapy technique regardless of whether it is traditionally applied with a tool or with just the hands. The soft-tissue therapy tool enables clinicians to seamlessly integrate a wide variety of both hand and instrument therapies and techniques with stellar results and ease of use. Self treatment is another designed strength of the soft-tissue therapy tool. A user can easily and effectively treat more than 90 percent of their own body, from the trapezius and teres muscles to the glutes, piriformis, calves, feet, hands, elbows, hips and knees. I was able to treat my carpel tunnel condition successfully with the prototypes I had created of the device. For therapists with limited treatment time, the tool can make a signi?cant impact in as little as a minute or two. It is especially good for isolated pressure points, cross-friction ?ber and myofascial release techniques. This tool is extremely efficient because of the increased leverage and mass that add a tremendous value to the practitioner. They will only need a fraction of the force that they would normally apply to implement the treatment. It is much easier to guide the weight than it is to create the force. The ability to "feel" the tissues is greatly enhanced when utilizing this instrument, much like a needle on a record player as it picks up the vibrations of the music. Treatment with the device is a very stable, comfortable and balanced experience for the therapist. One of the central design elements was to free up the therapist's ?ngers during the treatments so they could be used in conjunction with the instrument to stay in full patient contact. Now, clinicians have twice as much feedback since both the instrument and their ?ngers are actively involved in the treatment. The key thing here is that the instrument by design absorbs all of the treatment force through the palm of the hand and not the ?ngers. Therapists should see the soft-tissue therapy tool do the treatment and let it work for them.   Michael Conchard is an exercise physiologist and the president of Soft Tissue Therapy Tools in Indianapolis.

Fibromyalgia and Chronic Myofascial Pain

As I mentioned before when I find a good article online I will provide some or all of the information here in this blog.  I definitely do not want to take credit for the information that I will use from time to time. So please follow the author online for additional information by the author.

Here is a very good article on the difference between Fibromyalgia and Chronic Myofascial Pain, and Myofascial Trigger Point Pain.  These are confusing and sometime will show up in the same patient. However, as a very wise physician I trained with told me " first get rid of all of the myofascial trigger points and myofascial pain then see how much of the fibromyalgia is left". 

Dry Needling is a very effective way of treating myofascial trigger points and the referred pain that they create. At times it is too difficult to get to the trigger point using conventional manual trigger point techniques such as INIT ( Ischemic Neurologial Inhibition Technique), or ART (Active Release Techniques).  In these instances the dry needling works wonderfully.  If questions please email me.

Thanks:

Here is the article:

Published Online: Monday, June 25th, 2012
Karen Cooksey

Myofascial pain syndrome and fibromyalgia are common forms of musculoskeletal pain that are often confused with each other, not only because of similar symptoms, but also because they frequently occur in the same patient, which can lead to difficulties in differential diagnosis and treatment.

Fibromyalgia was previously diagnosed using the 1990 American College of Rheumatology (ACR) criteria (http://1.usa.gov/KRiJWi), which required that physicians perform a Tender Point Test, a physical exam that focuses on 18 specified tender points throughout the body. A diagnosis was made when pain had been present in all four quadrants of the body for over three months’ duration and at least 11 of these 18 points elicited pain upon digital palpation. The 1990 ACR criteria did not take into account any symptoms other than pain. In 2010, a preliminary new set of ACR criteria were published in Arthritis Care & Research (http://bit.ly/KRLXEr), in which the Tender Point Test had been replaced by an assessment of pain (ie, the number of painful areas from a checklist of 19 specified areas) and severity of other symptoms (including fatigue, waking unrefreshed, and cognitive problems) over the past week. One reason that patients with fibromyalgia experience a number of symptoms other than pain was suggested by a study by Geisser and colleagues (http://1.usa.gov/KRM2b8) that found that fibromyalgia is associated with central sensitization.

Unlike fibromyalgia pain, the pain in myofascial pain syndrome is more localized or regional (along the muscle and surrounding fascia tissues) and is associated with localized small hypersensitive nodules (ie, taut bands), known as myofascial trigger points.

Over the years, attempts have been made in the literature to differentiate between the tender points associated with fibromyalgia (http://1.usa.gov/NprJ62) and the trigger points associated with myofascial pain syndrome (http://1.usa.gov/M7MrHW). However, many researchers use the terms interchangeably, and many patients have both tender and trigger points, causing confusion and complicating diagnosis. “I have long maintained that tender points and trigger points are one and the same,” says Robert M. Bennett, MD, professor of medicine and nursing at Oregon Health and Science University.

Results of a study published by Ge and colleagues (http://1.usa.gov/LTDmTs) suggest that fibromyalgia pain may be due in large part to active (vs. latent) myofascial trigger points. In this study, 30 patients with fibromyalgia and 30 healthy age- and gender-matched controls were asked to draw all areas of their current spontaneous pain on an anatomical map and rate the overall intensity of their pain. The location of all active trigger points was then determined in the fibromyalgia patients using manual palpation. A total of 308 active trigger points were found in the 30 patients with fibromyalgia, and 305 of these were confirmed by spontaneous electrical activity demonstrated on needle electromyography. The locations of these 308 active myofascial trigger points were then mirrored onto the 30 healthy controls as an aid to identifying latent trigger points, and spontaneous electrical activity was found in 304 of these latent points. The authors concluded that most of the tender point sites were trigger points, with local and referred pain from active trigger points partly reproducing the overall spontaneous pain pattern. The total number of active trigger points was positively correlated with the spontaneous fibromyalgia pain intensity. This study provided evidence of the importance of active trigger points, which may serve as peripheral generators of fibromyalgia pain, and the authors suggested that inactivation of active trigger points may be an alternative for the treatment of fibromyalgia.

The findings of Ge and colleagues have been replicated by Alonso-Blanco and colleagues (http://1.usa.gov/KEvy87), who also found that widespread pain hypersensitivity in fibromyalgia patients was related to increased numbers of active myofascial trigger points.

In a 2011 editorial (http://1.usa.gov/Kn05Zo), Bennett described the technique for distinguishing between active trigger points (which are found in patients with fibromyalgia) and latent trigger points (which are found in healthy individuals). “Gentle palpation should be performed across the direction of the muscle fibers in order to identify a region of tenderness and nodularity (that is, the taut band). Continued firm palpation of a myofascial trigger point for at least 5 seconds is required to elicit the typical distribution of referred pain. An active myofascial trigger point is deduced if firm pressure over the taut band reproduces the patient’s spontaneous pain symptoms. If the pain symptoms are not reproduced, the tender area is designated a latent trigger point.”

This is another great video on Dry Needling.  In this video this doctor is treating the gluteal muscles and the IT band.  These trigger points are common in runner's and other athletes as well as a common component with certain low back problems. 

As promised I am going to include links to different information links for Dry Needling.  This is such a visual experience for the therapist in order to watch for Local Muscle Twitches and response I feel videos provide a good medium for learning and talking about Dry needling.  So try out this link, and email me if you have any questions.   My email address is kptasteve@gmail.com .  Thanks for watching.


https://www.youtube.com/watch?v=qhVLL9Vnnrg&feature=player_embedded

I am not going to hide the fact that I am going to use this site to provide the best of articles and information I find on the internet regarding Dry Needling.  I hope that this will provide a good collection of ideas and information on Dry Needling.    Thanks for reading.

Here is one example of what I experience from the sports area of Dry Needling :

Dry Needling for Tensor Fascia Latte TODAY! posted at 6/7/2012 6:38 AM CDT

Gamegirl Posts: 6 First: 5/7/2012 Last: 6/7/2012

Well, its been 3 months without running...I have had PT now for the past several weeks..pain going nowhere! PT says I have "knots", several of them!!  Or sometimes called "Trigger Points" on my hip. Until they go down, pain won't go away.  He is trying to build up my strength in the meantime on my core area to help me when I can run again.  He says I'm a perfect candidate for dry needling & I am leaving in a few hours to try it!  Very nervous but I will try anything at this point.  I have had 2 ultra sound massages that usually leave me pretty sore since its directly on these knots so I'm pretty sure this isn't going to be a fun visit...Anyone else tried this & had success?? If it helps, I'll be sure to let you know so maybe I can help someone else who is going through same ordeal.  Good to have support groups here!!

Advanced Dry needling in Kentucky

This is the beginning of a new phase of my physical therapy career.  I have been working at a pain center in Lexington for eight years developing my skills with a pain relieving technique called Dry Needling.  Sounds scary but has been wonderful for many of my patients and clients that I have worked with.  The pain relief has been nothing short of amazing in some of the wonderful people I have had the pleasure of working with.

I wanted for some time to be able to branch out and work more with this as a specialty and now seemed the most opportune time.  I am developing this blog to share the adventures of starting a new practice and sharing the benefits of dry needling.

I hope to be able to share this on a regular basis.