Dry Needling

Question 1

what is a myofascial trigger point

Answer 1

a hyperirritable spot within a
taut band of skeletal muscle that is painful on compression, stretch,
overload, or contraction of the tissue which usually responds with a referred pain that is perceived distant from the spot.

Question 2

active myofascial trigger point

Answer 2

those TrPs that upon
stimulation reproduce any symptom experienced by a patient, partially or
completely, and whereby the
reproduced symptom is recognized as a familiar experience by the patient

Question 3

latent myofascial trigger point

Answer 3

clinically quiescent with
respect to spontaneous pain; it is painful only when palpated

Question 4

integrated trigger point hypothesis

Answer 4

• increased Ach at synaptic cleft, changes in Ach receptor activity in number of receptors and down regulation of acetylcholinesterase
• muscle nociceptors become activated from release of ATP, bradykinin, 5-hydroxytryptamin, serotonin, prostaglandins, and K from muscle
• Nociceptor activation causes release CGRP from the motor nerve terminal and from the muscle nociceptors
• increased motor endplate activity

Question 5

biochemical changes within active MTrP

Answer 5

• lower pH
• higher SP, CGRP. BK, norepi, 5-HT, tumor necrosis factor 1a and interleukin 1 compared with latent MTrPs and with normal control subjects

Question 6

cinderella hypothesis

Answer 6

• Smaller motor units
  fire first, and larger
  motor units last
• Larger motor units
  turn off first, so
  smaller motor units
  can become overused

Question 7

5 types of manual trigger point therapy

Answer 7

• trigger point compression
• trigger point pressure release/myofascial release
• manual techniques such as occipital release
• transverse friction massage
• spray and stretch

Question 8

definition of dry needling

Answer 8

Dry needling is a skilled intervention using a thin filiform needle to
penetrate the skin that stimulates myofascial trigger points, musculature and connective tissue for the management of
neuromusculoskeletal disorders

Question 9

what is a local twitch response

Answer 9

a brief and sudden contraction of a MTrP taut band with needle insertion; a spinal cord reflex

Question 10

dry needling precautions

Answer 10

• needle aversion/phobia
• cognitive impairment
• cant give consent
• local skin lesion or wound
• local or systemic infection (except Lyme)
• local lymphedema
• following surgical procedure where capsule has been opened (THA,TKA)
• hyperalgesia or allodynia
• nickel or chromium allergy
• abnormal bleeding
• compromised immune system

Question 11

DN contraindication

Answer 11

• 1st trimester of pregnancy
• vascular disease/varicose veins
• at level of laminectomy
• over abdomen in pregnancy
• over implant
• state practice act

Question 12

post needling

Answer 12

• post needling soreness possible
  for 24-48 hours
• bruising possible
• avoid open water or potentially dirty water for 24-48 hours
• precautions with strenuous
  exercise post needling (24 hours)

Question 13

IL practice act for DN

Answer 13

• 1 year post DPT
• 30 hrs didactic work specific to intramuscular manual therapy
• 54 hours in intramuscular manual therapy opus work approved by FSBPT within 12 mo
• no retained needles or needle stimulation
• 200 documented patient treatment sessions with general supervision

Question 14

needle size for quads

Answer 14

50-60mm

Question 15

needle size for hammies

Answer 15

50-60mm

Question 16

how to insert needle into hamstrings

Answer 16

angling either medially or laterally to avoid the middle 1/3 of thigh bc sciatic n and avoid popliteal fossa

Question 17

needle size for ECRL/B

Answer 17

30-40mm