Dry needling procedure for a number of back muscles. This is a thorough and concise summary of everything you need to know when dry needling muscles of the back including, anatomy, pain referral, signs and symptoms, patient and trigger point examination, needling procedure and other important consi...
Abbreviations:
● Abom = abdominis/ abdominals ● Med = medial
● Abd = abduction ● Min = minor
● Accel. = accelerate ● MOI = mechanism of injury
● ACJ = acromioclavicular joint ● Movts = movements
● Ant = anterior ● MS = multiple sclerosis
● Anterolat = anterolateral ● OA = osteoarthritis
● Artic = articular ● Opp = opposite
● Ax = assessment ● || = parallel
● Bilat = bilateral ● Pec = pectoralis
● BL = bilateral ● Posterolat = posterolateral
● Btw = between ● Prop = proprioception
● Caud = caudal/ly ● PT = Physiotherapist
● ℅ = complains of (complaint) ● Pt = patient
● Contralat = contralateral ● r/f = referral
● EOR = end of range ● Rhom = rhomboids
● ER = external rotation ● ROM = range of motion
● Esp = especially ● Scap = scapula
● Extern = external ● SCJ = sternoclavicular joint
● Exam = examine ● SIJ = sacroiliac joint
● # = fracture ● SL = side lying
● Fxn = function ● Sp = spinous
● GHJ = glenohumeral joint ● Spont = spontaneous
● Glut = gluteus ● Supraspin = supraspinatous
● Interscap = interscapular ● thr = through
● Ipsilat = ipsilateral ● T maj = teres major
● IR = internal rotation ● T min = teres minor
● Jt = joint ● TP = transverse process
● Lev scap = levator scapulae ● TrP = trigger point
● Ligs = ligaments ● Tx = thoracic
● LLD = leg length discrepancy ● Unilat = unilateral
● LTR = local twitch response ● Vert = vertebra/e
● M = muscle ● w/ = with
● Maj = major ● w/o = without
, Levator Scapulae:
Origin Insertion Innervation Function
CI to CIV transverse Upper portion medial C3 to C4 and dorsal Elevates scapula
processes border of scapula scapular nerve (C4, C5)
Signs and Symptoms:
- Pain at the angle of the neck
- Painful “stiff neck”
- Unable to perform full:
- ipsilat rotation due to pain on contraction
- Contralat rotation due to painful muscle tension
- Neck flexion (blocked at end of movement)
- Pt tends to hold the neck rigid (compensating by turning the eyes or body)
Patient Examination: Referred pain:
Observe:
- neck and shoulder postural asymmetries
- Active head/neck rotation
Activation and perpetuation of TrPs:
- ergonomics / occupational stresses e.g.
- sitting in chair w/ armrests too high
- Walking w/ cane too long
- Sleeping with neck tilted, shortening lev scap
- Lev scap may be overloaded when TrPs inhibit the fxn of serratus anterior
Trigger point examination Needling
1. Central TrP - Contralat SL w/ pillow supporting the head
- At the angle of the neck - 30-40mm needle
- Contralateral SL w/ neck supported or in 1.
supine (better for upper traps relaxation) - Pt faces away from PT
- Face and neck slight contralat rotation - Pt body angled across the plinth near the PT
(to tighten and lift lev scap) - Arm rests on side of body w/ elbow bent for balance
- Upper traps must be slackened - More tension: full medial rotation w/ hand across the
2. Attachment TrP back w/ scapular winging
- Where the muscle attaches to the - PT presses aside the free border of upper traps +
superior angle of the scapula palpates lev scap
- Contralat SL - Fix the TrP against a transverse process
- Cross-fiber palpation +/- 1.5 cm above - Direct needle anteriorly toward TrP but away from
superior angle of scapula ribcage.
- Initially feels indurated and tender 2. Needle if soreness persists after 1
→ gritty (like gravel) or scar-like when - Scapula abducted – pt bends forward w/ round shoulders
stressed for some time to stretch and thin out the traps
- Enthesopathy from sustained TrP - Rub a finger transversely across M fibers
tension - Insert 40 mm needle upward aiming to be parallel to the
rib cage
Entrapment: No
Differential Diagnosis:
Bursitis and articular dysfunction
Decr neck movt (whereas with upper traps TrPs pt
continuously tries to stretch neck)
Related TrPs:
● Splenius cervicis likely involved with “stiff neck”
syndrome
● Scalenus medius and iliocostalis cervicis
● Strong neck lateral flexion likely due to SCM
TrPs
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