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Tuesday, March 13, 2018

Study Spotlight: TpDN in Upper Trap vs. Infraspinatus in Overhead Athlete w/ Shoulder Impingement Syndrome

By: Joel Luedke

Trigger points have been a highly 'researched' source of pain and problems in the body.  Why the mini quotes?  Well it can be hard to identify directly what they are and where they are.  The information that is coming out is improving but there still is a lot of work to do in order to get a really clear picture of that they truly are.

What They Did:
There were 40 overhead participants that had unilateral shoulder impingement (dx. with Neer's and Hawkins test).  They were randomly split into a group that would get TpDN into the upper trapezius or infraspinatus muscles.   There was three sessions of TpDN treatment, each separated by a 2 day break.  The outcome measures they were looking at were the change in Pain intensity (visual analog scale), pain pressure threshold (PPT) and disability in the arm, hand and shoulder (DASH).

What They Found: 
Pain and disability decreased significantly in bot groups along with PPT increasing only in the inframspinatus group.  However there was no outcome measures that showed a significant inter-group difference after treatments.

What It All Means:
What the researchers found is the using TpDN for active trigger points in the infraspinatus can be as effective as direct TpDN of active trigger points in the upper trapezius in improving pain and disabilities with shoulder pain.  This could be really beneficial as it seems to work out in terms of pain to go after the infraspinatus instead of the upper trapezius.  The upper traps can be an area of extreme tightness and pain and even with using TpDN to release those issues it can be extremely intense and also a little painful.  That does leave some questions though about how are you actually treating what you think is the pain, if it turns out it isn't the pain...

For more discussion on that here is what we have...
Where to Treat?
The results that they found in this study could be confusing.  We treated two different areas and they seem to have a similar effect on pain.  So how do we know where the pain is coming from?  This is a unique aspect of pain in that just because the pain is located in a specific spot it most commonly is just a symptom of a much bigger problem (we discuss below).  I think it would be interesting to show if this improvement could possibly come from treating both areas and if that would have a cumulative effect.

Focus on a Bigger Picture for Treatment
As much as we think we understand injury and pain I think we are only scratching the surface.  I like to think I attempt to stay relatively up to date with as much as I can with that latest happening in sports medicine and everything but the rate that the data comes out makes it impossible to keep up.  That being said even looking at a specific point of pain there are a lot of factors that could be the contributing factor.  I think that the results of this study show that pain is so multi-factorial that you have to look at multiple areas that could be having an effect.  That may occur even if the referral patterns don't quite make sense.


Overall this is a great step to adding into trying to figure out exactly where pain and issues can come from.  Don't let conflicting or confusing data slow you down.  Keep it in your toolbox and you'll never know when you need to apply it.


Source: Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes with Unilateral Shoulder Impingement Syndrome

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