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.

No comments: