Filed under: Movement Dysfunction, Myofascial Trigger Points, Pain Sciences, Tissue Pathology
Thank you to Georgia Representatives Sharon Cooper and Edward Lindsey, the use of dry needling in clinical practice has been adopted into the Georgia Physical Therapy Practice act under bill HR 145. Dry needling is a technique to improve myofascial pain and dysfunction, which includes treatment of trigger points. With proper clinical reasoning and treatment methodology, trigger point dry needling can help significantly with improvements in pain, dysfunction, range of motion, and movement patterns. For more information please view our website: www.motionstability.com
For more information on the bill follow this link.
Filed under: Nerve
In the March 2009 Journal of Orthopaedic Sports and Physical Therapy, Dr. Coppieters demonstrated that specific movement of the nerve caused different lengths of movement along the median nerve, measured by real-time ultrasound imaging. Greatest movement was found with a neurodynamic slider, with less in a neurodynamic tensioner. This helps us with our clinical reasoning process in treatment rationale when selecting specific nerve mobilizations and exercises for nerve rehabilitation, including sciatica and other radiculopathies.
In the Journal of Orthopaedic Research – September 2006, Coppieters MW, Alshami AM, Babri AS, et al measured the strain and excursion of the sciatic, tibial and plantar nerves with a modified straight leg raise (SLR) test. By bending the ankle into dorsiflexion first before raising the leg, nerve movement at the ankle, particularly the tibial nerve was greatly increased. Clinically, the diagnosis of ‘plantar fascitis’ can be caused by multiple sources, one being sensitization of the tibial nerve which is a branch of the sciatic nerve. Thanks to Dr. Coppieters, as well as other neurodynamic specialists like Michael Shacklock MAppSc, DipPhysio, we now know that movement of nerves occurs greatest where joints move first, a concept called ‘neurodynamic sequencing’. By sensitizing the tibial nerve through the SLR test, or even a slump test (picture shown) we can differentially diagnose plantar fascitis as a peripheral nerve disorder.
Filed under: Nerve
In patient care with complaints of recurring low back pain and sciatica. Patients need to consider that even though pain subsides down the leg through rest or interventions. That the sciatic nerve can become adhered through intraneural edema. And similar to a stiff elbow after removing a cast off it due to a fracture, the elbow may not be as painful but will be very stiff. Likewise, a reduction in symptoms down the leg, does not necessarily mean that the sciatic nerve is mobile. Thorough testing for nerve mobility, that is asymptomatic but could be asymmetrical to the unaffected side, at least from my clinical opinion, could be a factor to recurring sciatica and low back pain.
In, Hoskins W, Pollard H. Hamstring injury management – Part 1: Issues in diagnosis. Manual Therapy 2005;10:96-107, the authors provide a research review of the possible factors in hamstring injury.
Muscle strength and balance: Various studies have found different ratios in quadriceps and hamstring strength ratios, which could be dependent on the specific sport.
Warm up: There is a lack of literature existing to identify best warm-up procedures Fatigue: The authors showed that fatigue is a factor as the incidence of hamstring injuries occurred greatest at the end of a games or matches (Woods 2004).
Flexibility: There is conflicting evidence on the relationship of hamstring flexibility and injury.
Body Mechanics: The authors found that poor lumbo-pelvic mechanics can indirectly cause hamstring injury, showing that increased anterior pelvic tilt can be a causative factor by means of the loss of power of the gluteal muscles in this position
Psychosocial Factors: Even without conclusive evidence, the authors believe that psychosocial assessment of the patient should be considered.
Running Technique: Forward leaning may be a causative factor in hamstring injuries as it increases its relative length and inhibits gluteus maximus contraction. In my clinical experience, I have found altered lumbo-pelvic and lower extremity mechanics are common reasons why patients sustain a hamstring injury. We will continue to explore how abnormal lumbo-pelvic and lower extremity mechanics can lead to hamstring injuries as well as other leg injuries in this blog site… stay tuned!
