Wednesday, February 21, 2018

Study Spotlight: Spinal & Peripheral TpDN vs. Peripheral TpDN on Individuals w/ History of Lateral Ankle Sprain

By: Joel Luedke

Trigger point dry needling (TpDN) has been around for a long time but seems to just recently come into popularity as a powerful soft tissue modality.  The idea of trigger points has also been around for a long time and while some live by it others aren't always convinced.  In my short time working with it I have found good results but when I was taking the course the instructor mentioned you really see who knows what they are doing if they are looking at the spinal areas that could affect the peripheral areas in their treatment.  Naturally this study peaked my interest and hence why we did the Study Spotlight on it.  Check it out.

What They Did:
Researchers took a look at a group of 20 individuals with a history of ankle sprain performed on a specific set of tests prior to a TpDN treatment.  The groups were randomly put into a group that had TpDN done along the L5 multifidi as well as the fibulas longs and brevis muscles  on the involved lower extremity.  The other group just had the peripheral muscles dry needling.*  The testing was then redone immediately after intervention and again 6-7 days after intervention.
Tests Included:
  • Foot and Ankle Disability Index (FADI)
  • Cumberland Ankle Instability Tool (CAIT)
  • Strength 
  • Unilateral balance
  • Unilateral hop test

What They Found:
In comparison of both the immediate post test and again approximately a week later there was no significant change in the scores of the testing when the multifidi were dry needled along with the peripheral muscles.  There was some evidence to support short term improvements in strength and unilateral balance with the peripheral TpDN intervention.

What It All Means:
This study showed there was no difference int he group when the addition of TpDN to the multifidi.  What could that mean?  The idea behind looking at treating the multifidi is that if there is a compression of the joint space or a decrease in the space for the nerve root as it leaves the spinal column, there could be peripheral symptoms.  It is not easy to palpate the multifidi and know if there are trigger points present in the muscle due to the complex anatomy of the spine and the overlying muscle that cover these small muscles.

The study did show that there was some improvement with TpDN of the fibularis muscles which gives potential to TpDN as a solid treatment to help with pain and also improve performance, at least in the short term (other soft tissue work could maybe do the same).  Where we think you might add in the multifidi work is if you weren't getting pain relief completely or a resolution of symptoms going directly for the Tp in the muscles.  It may not be necessary each time to work on the multifidi but in some cases it may be warranted due to the unknown of trigger points in these muscles.  Lots more research to be done here.

Resource: Rossi, Ainsley.  Spinal and peripheral dry needling versus peripheral dry needling along among individuals with a history of lateral ankle sprain: a randomized controlled trial.  IJSPT.

*There was no shame treatment given to the peripheral TpDN group to mimic spinal TpDN.  This could bring in potential bias to the study due to expectations that one could work better than the other.

Sunday, February 18, 2018

Mobility Monday: Unglue Your Posterior Chain

Deadlifts are/used to be one of my favorite exercises and as I got better at them I found out being able to sit down further into the set up can make a huge difference.  Where that tightness can occur can be in the anterior hip and is one to be addressed but it is commonly along the posterior chain.  This can occur from sitting down for long periods of time throughout the day and also having some postural faults.  These basic movements can really help you get moving.

You don't need to send a huge amount of money on a specific ball and a softball or lacrosse ball will do the trick.

LINK: Lacrosse ball
LINK: Softball

Things It Helps:
-Hip Flexion
-Getting deep into a squat to set up
-Potential referred pain patterns of a disc

Thursday, February 15, 2018

Friday Food: Beef and Broccoli

A little change in flavor in this weeks Friday Food.  Going a little more with the eastern cuisine but you can make it up anytime you need and also make up really large batches to help set you up for the week.  Enjoy.


  • 1 1/2lb. sirloin steak, thinly sliced
  • 1 c. low sodium beef broth
  • 1/2 c. low sodium soy sauce
  • 1/2 c. brown sugar
  • 3 tbsp sesame oil
  • 1 tbsp. sriracha
  • 3 cloves garlic, minced
  • 3 green onions, thinly sliced, plus more for garnish
  • 2 tbsp. cornstarch
  • 2 c. broccoli florets
  • Sesame seeds, for garnish
  • Cooked jasmine rice, for serving
The Game Plan:
  1. In a large slow-cooker, add steak.  Add beef broth, soy sauce, brown sugar, sesame oil, Sriracha, garlic, and green onions.
  2. Cover and cook on low until beef is tender and cooked through, 3 1/2 to 4 hours.
  3. When the steak is tender, spoon a few tablespoons of the slow cooker broth into a bowl and whisk with cornstarch.  Pour into slow cooker and toss with the beef until combined.  Add broccoli and cook, covered, 20 minutes more.
  4. Garnish with sesame seeds and green onions and serve over rice.
Recipe via Delish

Monday, February 12, 2018

Foot Up? Hip Down? Chicken or the Egg?

By: Joel Luedke

I've had this conversation with a bunch of different people when it comes to looking at the knee and what all contributes to the motions it must withstand.  Which comes first?  Do we control more of the resultant motion at the knee from our foot position and placement or from the control and strength we have in our hips?  We will dive into that question in this post as I think I can make an argument for both sides. But first, how it all relates to the knee.

How the Knee Moves
The knee anatomically has a few different degrees of motion.  The main ones that everyone knows is flexion and extension (bending and straightening your knee).  Not everyone knows that there is a degree of rotation that occurs at the knee but it is typically mainly at the end of extension and then on the invitation of flexion.  The knee can move into values and varus (in and out) but that isn't what we would consider normal.

The two main bones that make up your knee are the femur and the tibia and contribute most to the movement.  The fibula is there along with the tibia and then the patella is obvious as it acts as a lever for movement.  When we move, run, jump, etc we can have valgus/varus movements of the knee but that doesn't come solely from the knee joint as it has to follow either how the tibia or the femur direct it.

Now onto why that might occur.

Working from the Hip Down
There is a reason that we chose this one first and that is because I think it plays a 'bigger' role in controlling the movement of the knee and we'll explain why.  The external rotator muscles of the hip
start really small and get to fairly large and very strong.  If you have these muscles working properly you can control so much about how your leg(s) move.  A simple test is to stand up, squeeze your glutes to rotate your leg outwards (while standing) and if you do it slowly you can feel everything rotate out through your femur, through the knee, along the tibia and even to raising up your arch.  

This is why we argue that increasing lateral/external hips strength and 'function' might be the most important area to start with when it comes to working on control of the knee all the way down to the foot.  This is often the cornerstone of ACL prevention programs and there is often a huge area of improvement that can come from focusing attention here.

Working from the Foot Up
I can definitely see the argument for working from the foot up and setting up a good and stable foot to help keep the knee in place.  Focusing on 3 (or more depending on who you ask) points of contact and pressure on your feet (ball of foot, head of 5th MET, center of heel) you can help create a good and stable arch.  This then translates into a good position for your tibia and we work back up the kinetic chain.  I see this as extremely beneficial but also struggle with seeing how it then moves from the knee to the hip and controlling the position of the femur.

How I like to address things is to start from the hip and work down all the while keeping your foot in a good position.  This allows us to attack it from both ends and that can be very powerful.  Having good control over your knee and how you are moving through both your hips and feet can have profound effects on the health of your knees and also increase your performance.

Which way seems to work best for you?

Sunday, February 11, 2018

Mobility Monday: Upper Back and Neck Pain Relief

We don't feature Yoga Tune Up as often as we should on the blog and so we wanted to make sure we went back to them because they are for real when it comes to using tools to do your own soft tissue release.  Here they feature working on tight upper backs and necks.  Tightness in these areas can really affect your daily life not so much from the source but where it causes pain to occur.  Give this one a try.

Things It Helps:
-Tension Headaches
-Sore Upper Shoulders
-Assisting with Upper Crossed Syndrome