1 / 83

Trigger Point Workshop

Trigger Point Workshop. Phillip Snider, RD, DO Amelia Medical Associates Bon Secours Medical Group Norfolk, VA. Common Complaints. Headaches Low Back Pain Tennis Elbow Post-surgical Neuropathic Pain Runners Glutes TFL Hamstring Gastroc / Soleus FDB. Treatments. OMT

zeal
Download Presentation

Trigger Point Workshop

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Trigger Point Workshop Phillip Snider, RD, DO Amelia Medical Associates Bon Secours Medical Group Norfolk, VA

  2. Common Complaints • Headaches • Low Back Pain • Tennis Elbow • Post-surgical Neuropathic Pain • Runners • Glutes • TFL • Hamstring • Gastroc / Soleus • FDB

  3. Treatments • OMT • TPI (trigger point injections) • Neural Therapy • PT • Posture education • Watch for trigger point irritation • Muscle relaxants

  4. Treatments cont’d • NSAIDs – po, gel, drops, patch • Lidoderm patch • Tylenol • Narcotics • Short term use is best • Narcotic contract is a must • Urine drug testing • Drug monitoring system – pill counts, PMP • HA Meds (BB, CCB, Antiepilectics)

  5. Trigger Point Injections • 0.25% Lidocaine w/ NaHCO3 • 1cc into each muscle • 30ga 1.5 inch needle • Avoid use in face and forearm • Dry Needling (Acupuncture needle) • My favorite: Lhasa OMS (www.lhasaoms.com) • Name brands: • Seirin • Hwa-to

  6. Trigger Point Injections Needle Diameter Hypodermic Gauge

  7. Trigger Point Injections • Needle Sizes • .30 x 50 mm for most muscles • .30 x 60 for QL • .30 x 75 for psoas or glutes in obese pt • .20 x 25 mm for forearm • .14 x for face / head • .12 x for hands / feet

  8. Headaches • Migraines • IHS Criteria • Anyone can get one • Triggers often include MSK component • Most Common Offenders • Traps • SCM • Levator Scapulae

  9. IHS Migraine Criteria • 4+ HA lasting 4 - 72 hr, 2 of the 4 with: • Unilateral location • Pulsating quality • Moderate or severe intensity (affecting ADLs) • Aggravated by walking stairs or similar routine physical activity • During headache at least 1 of the 2 following symptoms occur: • Phonophobia, photophobia or osmophobia • Nausea and/or vomiting

  10. Trapezius

  11. Trapezius Needling • Patient supine • Pincer grasp of muscle • Insert needle anterior to posterior • 30ga x 1.5” or .30 x 50mm • Muscle twitches can be significant

  12. Levator Scapulae

  13. Levator Scapulae Needling • Patient prone • Insert needle at shallow angle toward superior angle of scapula • .30 x 50mm or 30ga x 1” • DO NOT insert needle posterior to anterior • Muscle twitch is moderate

  14. Sternocleidomastoid

  15. SCM Needling • Patient supine • Pincer grasp of muscle • 30ga x 1” or .30 x 50mm • Avoid external jugular (bruising) • Insert needle only through portion of muscle you’re holding • Muscle twitch is moderate • Responsible for many ENT-like symptoms

  16. Low Back Pain • Common muscle trouble makers: • QL • Iliopsoas • Multifidis • Iliocostalis & Longissimus • Glute medius

  17. Quadratus Lumborum

  18. QL Needling • Patient on side, affected side up • May need pillow under unaffected side • 1 – 2” posterior of iliac crest apex, approx ½ way b/w there and rib 12 • Insert .30 x 50mm or .30 x 60mm needle lateral to medial toward midshaft of spinous process

  19. QL Stretch

  20. Iliopsoas

  21. Iliopsoas Needling • Patient prone • Insert .30 x 75mm needle posterior lateral to anterior medial through QL • Patient on side • Insert a .30 x 75mm needle posterior lateral to anterior medial lateral through QL; aim for base of transverse process

  22. Iliopsoas

  23. Iliopsoas Stretch

  24. Multifidus

  25. Multifidus Needling • Patient supine • Safety zone is 1 finger width lateral to spinous process • Insert .30 x 50mm needle from posterior lateral to anterior medial; aim for base of transverse process and lamina

  26. Iliocostalis & Longissimus

  27. Iliocostalis & Longissimus Needling • Patient prone • .30 x 50mm needle • Identify trigger point • Use index and middle fingers to block the adjacent intercostal spaces • Insert needle using shallow angle

  28. Gluteus Medius

  29. Glute Medius Needling • Patient on side • .30 x 50mm needle into trigger point • Muscle twitch ranges from barely noticeable to fairly strong • Can mimic greater trochanteric bursitis

  30. Tennis Elbow • Don’t Forget - Joint Above and Below • Shoulder • Radial head • Wrist • Myofascial Pain Referral Patterns • Trigger Point Injection/needling • Don’t use Lidocaine near the radial nerve

  31. Supinator

  32. Supinator Needling • Have patient supinate forearm to identify muscle • .20 x 25mm needle

  33. Brachioradialis

  34. Brachioradialis Needling • Pincer grasp of muscle • .20 x 25mm needle • Insert needle only through portion of muscle you’re holding • Mimics OA pain in the 1st MTP • Mimics scaphoid pain

  35. ECRL

  36. ECRL Needling • .20 x 25mm needle • Muscle twitch is strong

  37. Extensor Digitorum

  38. ED Needling • .20 x 25mm needle • Muscle twitch is strong

  39. Triceps

  40. Triceps Needling • Pincer grasp of muscle • .30 x 50mm needle • Insert needle only through portion of muscle you’re holding • Review anatomy to avoid median nerve and radial nerve • Muscle twitch is strong

  41. Anconeus

  42. Anconeus Needling • .20 x 25mm needle • Muscle twitch is vague to moderate

  43. Supraspinatus

  44. Supraspinatus Needling • Pt seated or prone • 30ga x 1.5” or .30 x 50mm needle • You must identify the spine of scapula • Insert needle anterior to posterior and medial to lateral • Muscle twitch is vague • Very common trigger point in shoulder pain

  45. Infraspinatus

  46. Infraspinatus Needling • Pt seated or prone • 30ga x 1.5” or .30 x 50mm needle • You must identify the medial border and inferior angle of scapula • Muscle twitch is moderate • Very common trigger point in shoulder pain

  47. Serratus Posterior Superior

  48. Serratus Posterior Superior Needling • Patient prone • .30 x 50mm needle • Identify trigger point • Use index and middle fingers to block the adjacent intercostal spaces • Insert needle using shallow angle • Muscle twitch vague to moderate

  49. Serratus Posterior Superior Needling • Patient side-lying, affected side down • Arm internally rotated with hand behind back • Pull scapula away from ribs • Insert .30 x 50mm needle parallel to rib cage and scapula • Also treats: Rhomboid, Subscapularis, Serratus anterior

  50. Post-Surgical Neuropathic Pain (729.2) • Occurs due to surgical scar • Pain is burning and usually local • Neural therapy • Injection of 0.25% Lidocaine along scar • 30ga needle

More Related