jeudi 15 décembre 2016

. Dry Needling N°2- Trigger Point - BMN

. Dry Needling N°2- Trigger Point - BMN
Extension of the Dry and Wet Needling activity field
Dry needling can be appropriate and very helpful for Patients with chronic pain, of undetermined origin but clearly identified not to be of internal organ origin especially when other interventions have failed, although DN initiated being limited to the local area of pain only: Extending its field of activity in the treatment of any non-visceral chronic pain by TPs is also a classical approach to Acupuncture…
DN and needles
·                 Hypodermic needle, 1981.
In 1981, having found that, the effectiveness of the alone needle insertion, was identical to the liquid drug injection, TRAVELL & SIMONS recommended the use of a single hypodermic needle, without injection.
“In comparative studies, DN was found to be as effective as injecting an anesthetic solution such as procaine or lidocaine in terms of immediate inactivation of the TP”. 
DN focuses only, on treating the locally musculoskeletal pain and dysfunction by inserting hypodermic needles into the locally painful area.


Dry Needling DN is a treatment technique used in conjunction with other treatments to inactivate the TPs and treat pain and dysfunction they cause.
The interventionist therapist will not have to stimulate, in principle, any distal or auricular AP during the treatment with DN but he can find more than one TP in a muscle and more than one muscle with numerous TPs.
It was used originally in DN, a sterile hollow hypodermic needle, inserted in an empty or 'dry' syringe body (empty as opposed to a syringe filled with injectable solution used, in the Wet Needling) inserted through the skin and muscle, to reach directly the TP, without drug injection: Proper placement of the needle into the TP causes a localized muscle contraction.
Currently, is used an acupuncture needle, controversial use by Acupuncturists because Acupuncture Needle involves Care or Acupuncture session.

Whatever it is the needle is inserted into the TP, located in an area, the Taut Band, where the muscle is stretched, contracted and sensitive: The perceptible or visible flexion of this band of muscle fibers confirms the correct insertion of the needle into the TP.

It is an involuntary spinal cord reflex, in which the muscular fibers of the stretched muscle band contract, due to a reflexive relaxation and elongation of the muscle fibers, improving the overall muscular flexion and relieving altered motions.
Repeated movements of the needle, for about one minute in situ, in its insertion point, without completely removing it, help to inactivate the TP allowing, in the absence of pain and by an involuntary spinal cord reflex, the overall muscle contraction, its lengthening and improving flexibility. 
These manipulations can be painful, a fortiori if, more than one TP in a muscle requires needling and more than one muscle with multiple TPs, is involved: Perhaps a few drops of anesthesia would be appreciated, interesting possibility when using the BMN.

Mechanism of Action
The exact mechanisms of the therapeutic effects of the needle insertion into the TP are not fully understood, although the principle behind DN is known as being the reflex arc.
Studies, Dr. Jay Shah and colleagues and other Authors, have shown that Dry Needling,
·                 Disrupts mechanically the integrity of the dysfunctional endplates within the trigger area.
·                 Causes, locally, favorable biochemical changes which aid in reducing the pain, partially.
·                 Involves supra-spinal pain control via midbrain periaqueductal gray matter.
DN also affects the central nervous system about the perception and modulation of pain.

**- No mention is made of the role of connective tissue, its fundamental substance particularly, like the role described thereto, in Acupuncture, in the management of the therapeutic effect due to the implantation of the acupuncture needle in the soft tissue, into the APs location in the connective tissue.

Another hypothesis about the healing mechanism
  Dry Needling injures and causes minor bleeding within the tissues. The minor trauma elicits a local inflammation, recognized by the body as an acute problem area, requiring an increased blood flow while usually this area has a poor blood circulation. By increasing bleeding and blood flow into the tampered area the body tries allowing the area to heal.
·                 Acupuncture Needle, 1999.
In 1999, on the second edition of their book, Travell and Simons advocated, for disabling the TPs, to use an acupuncture needle, thin, compact and less painful than a hypodermic needle, wider in diameter.
This recommendation allowed the Professionals to mitigate the insertion and manipulation pain of the hypodermic needle into the TP, already spontaneously painful.
Moreover, hypodermic needle was described in unflattering terms, by the Therapists, as causing a searing pain and discomfort. 

The use of an acupuncture needle and confusion of many TPs with APs has aroused among Acupuncturists, a deep and sustainable controversy, yet noticeable today but also including some signs of lull.  

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