Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review

A Multimodal Chiropractic Approach to the Treatment and Management of Medial Elbow Injuries in Elite Javelin Throwers: A Case Series

Background

Sports chiropractors are increasingly being consulted in the assessment, treatment and rehabilitation of athletes. The purpose of this case series was to describe a multimodal chiropractic treatment approach to address medial elbow injuries in amateur/elite javelin throwers.

Case Descriptions

Five javelin throwers (3 Males & 2 Females) aged 15-24 years presented to two chiropractic clinics with signs/symptoms including pain, instability, postural dysfunction, and dysfunctional range of motion of the glenohumeral and elbow joints. Diagnoses included tear/rupture of the ulnar collateral ligament, medial epicondylitis, valgus extension overload syndrome (posteromedial impingement), reactive bone formation of the olecranon fossa, avulsion fracture of the medial epicondyle/sublime tubercle, distal triceps tendinopathy, scapular dyskinesis, glenohumeral internal rotation deficit, anterior glenohumeral capsulitis, instability of the glenohumeral joint, rotator cuff pathology, and subacromial impingement.

Interventions and Outcomes

A multimodal treatment approach was utilized for all five athletes which included; soft tissue therapy (active release techniques [ART]), ischemic pressure, cross-friction massage, dry needling, low level laser therapy (LLLT)/Photobiomodulation (PBM), spinal and peripheral joint manipulation/mobilization and a rehabilitation program that included proprioceptive and postural retraining, strength and Javelin specific technical retraining. Numeric rating scale (NRS), Conway scale, activities of daily living (ADL's) and sport specific functions were used to assess change. All javelin throwers returned to above pre-injury performance 12-26 weeks post injury presentation. At six and 12 month follow up all patients continued to be symptom free, performing normal ADL's and sport specific functions.

Conclusions

This case series presents results which demonstrate positive outcomes after using a multimodal chiropractic treatment and management approach in five javelin throwers with medial elbow injuries.

Level of Evidence

5 (case series).

Dry Needling with the Use of FRSc Technique in Addition to Standard Rehabilitation Program for Chronic Low Back Pain: A Randomized Controlled Trial Using Both PROMs and Measurement Tools

Purpose

Dry needling (DN) has gained popularity for musculoskeletal conditions, but its commercial use often surpasses scientific evidence. The novel Five Regulatory Systems Concept (FRSc) of DN shows potential therapeutic mechanisms, including chronic low back pain (LBP). However, rigorous clinical assessment with patient-reported outcome measures (PROMs) and objective measures are necessary. This study aimed to evaluate the effect of DN according to pain levels, postural control and selected gait parameters in patients with chronic LBP.

Patients and Methods

This prospective, double-blinded, randomized controlled study involved 30 patients with LBP allocated in the experimental (n=15, rehabilitation+ FRSc DN) or control group (n=15, rehabilitation + sham DN). The Roland-Morris questionnaire (RMQ) and Visual Analog Scale (VAS) were used as PROMs. Moreover, the posturography method for posture and balance control and the treadmill for gait analysis were used as objective tools. Measurements were taken before and immediately after the intervention and during 1- and 3-month follow up.

Results

There was a statistically significantly greater improvement in the RMQ in the experimental group compared to the controls (p=0.923 before and p<0.001 after treatment, as well as p<0.001 after 1 and 3 months). Despite the favorable analgesic effect, a significant advantage of the experimental group over the controls in this respect is worth noting (p=0.001 in favor of DN in all intergroup comparisons concerning results from the subjective assessment of pain (VAS). A statistically insignificant post-treatment improvement in balance and postural stability was noted in both groups, although the effects appeared to be short-term. Surprisingly, again, DN had no advantage over sham interventions. In both groups, all changes in the swing phase were statistically insignificant (p=0.201 for the dominant and p=0.283 for the non-dominant side) for the initial swing phase. In both groups, all changes in the stance phase were statistically insignificant (p=0.480 for the dominant and p=0.410 for the non-dominant side of the body).

Conclusion

DN based on the FRSc appears promising as an effective adjunct to standard rehabilitation for LBP, showing improvements in functional performance and pain reduction.

Pneumothorax as a complication of dry needling technique

Post-dry needling pneumothorax is not extremely rare. Patients and referring doctors should be aware of this. Informed consent should mention pneumothorax as a considerable risk of dry needling procedures in the neck, shoulder or chest region. https://bit.ly/49YYNR8.