Rainey Charles E
Physical Therapist, Naval Special Warfare Group ONE, San Diego, CA.
Int J Sports Phys Ther. 2013 Apr;8(2):145-61.
Case Report.
Myofascial trigger points (MTrPs) are widely accepted by clinicians and researchers as a primary source of regional neuromusculoskeletal pain. Trigger point dry needling (TrP-DN) is an invasive procedure that involves stimulation of MTrPs using an monofilament needle. The purpose of this case report is to report the outcomes of TrP-DN and intramuscular electrical stimulation (IES) as a primary treatment intervention in a subject with chronic low back pain.
The subject was a 30-year-old female, active duty military, who was referred to physical therapy for low back and right posterolateral hip pain. She noticed symptoms after suffering a lumbar flexion injury while picking up a barbell during weight training. Physical examination demonstrated findings that supported the diagnosis of lumbar segmental instability with a right hip stability dysfunction. Objective findings included a multi-segmental flexion movement pattern dysfunction and MTrPs in the right gluteus maximus and gluteus medius muscles with deep palpation. The subject was treated with TrP-DN and IES for a total of two visits. Bilateral L3 and L5 multifidus and right gluteus maximus and medius muscles were treated, along with implementing a home exercise program consisting of core stability exercises.
The subject reported no existing pain and disability on the Numerical Pain Rating Scale and Oswestry Disability Questionnaire and a large perceived change in recovery on the Global Rating of Change at final follow-up. Physical examination was normal, demonstrating no observed impairments or functional limitations, including normal multi-segmental flexion and no MTrPs with deep palpation.
The subject was able to return to full military active duty without any physical limitations and resumed pre-injury activity levels, including the ability to resume all activities without pain. There is much promise regarding the use of TrP-DN with IES intervention for the treatment of lumbar and/or hip stability dysfunction. Future research is recommended to determine if TrP-DN intervention, with and without IES, is effective for other body regions and long-term subject outcomes.
Level 4.
病例报告。
肌筋膜触发点（MTrPs）被临床医生和研究人员广泛认为是局部神经肌肉骨骼疼痛的主要来源。触发点干针疗法（TrP-DN）是一种侵入性治疗方法，即使用单丝针刺激肌筋膜触发点。本病例报告的目的是报告触发点干针疗法和肌内电刺激（IES）作为慢性下腰痛患者主要治疗干预措施的治疗效果。
该患者为一名30岁的现役女性军人，因下背部和右后外侧臀部疼痛被转诊至物理治疗科。她在重量训练中拿起杠铃时遭受腰椎屈曲损伤后出现症状。体格检查结果支持腰椎节段性不稳定伴右髋稳定性功能障碍的诊断。客观检查结果包括多节段屈曲运动模式功能障碍，以及通过深部触诊发现右侧臀大肌和臀中肌存在肌筋膜触发点。该患者接受了总共两次触发点干针疗法和肌内电刺激治疗。对双侧L3和L5多裂肌以及右侧臀大肌和臀中肌进行了治疗，并实施了包括核心稳定性练习的家庭锻炼计划。
在末次随访时，患者在数字疼痛评分量表和Oswestry功能障碍问卷上报告无现存疼痛和功能障碍，并且在总体变化评定量表上感觉恢复有很大改善。体格检查正常，未观察到任何损伤或功能受限，包括正常的多节段屈曲，深部触诊未发现肌筋膜触发点。
该患者能够在没有任何身体限制的情况下恢复全职军事现役，并恢复到受伤前的活动水平，包括能够毫无疼痛地恢复所有活动。触发点干针疗法联合肌内电刺激干预治疗腰椎和/或髋部稳定性功能障碍有很大前景。建议未来开展研究以确定触发点干针疗法无论是否联合肌内电刺激，对其他身体部位以及患者长期治疗效果是否有效。
4级。
