Rock Jodie M, Rainey Charles E
Naval Special Warfare Group ONE, San Diego, CA, USA.
Int J Sports Phys Ther. 2014 Oct;9(5):699-711.
Case Series.
Myofascial trigger points (MTrPs) are a common occurrence in many musculoskeletal issues and have been shown to be prevalent in both subjects with nonspecific low back pain and whiplash associated disorder. Trigger point dry needling (DN) has been shown to reduce pain and improve function in areas such as the cervical and lumbar spine, shoulder, hip, and knee, but has not been investigated in the thoracic spine. The purpose of this case series was to document the use of DN with intramuscular electrical stimulation (IES) in subjects with nonspecific thoracic spine pain.
The subjects were both active duty military males aged 31 and 27 years who self-referred to physical therapy for thoracic spinal pain. Physical examination demonstrated thoracic motor control dysfunction, tissue hypertonicity, and tenderness to palpation of bilateral thoracic paraspinal musculature in both subjects. This indicated the presence of possible MrTPs. Objective findings in the first subject included painful thoracic flexion and bilateral rotation in each of these planes of movement. Pain reduction was observed when postural demands of the spine and trunk musculature were reduced through positional changes. Patient 1 demonstrated pain with posterior to anterior (P/A) pressure at T9 to T12. The second subject had bilaterally limited and painful thoracic rotation actively with normal passive rotation and demonstrated pain with P/A pressure at T4 to T7.
The subjects were treated with DN and IES for a total of two visits each. DN was performed to paraspinal and multifidus musculature at the levels of elicited pain with P/A testing and IES set at a frequency level of 4 (1.5Hz) for 20 minutes.
Subject 1 reported reduced pain with standing flexion from a 62mm VAS score on initial evaluation to 26mm at his second visit. Subject 2 reported being "quite a bit better" in symptoms on the GROC following his second treatment. His VAS score reported following weightlifting activities changed from 43mm on initial evaluation to 20mm at his second visit. Both subjects also demonstrated a 10 degree improvement in active thoracic spinal rotation (on the right for Subject 1 and bilateral for Subject 2) following their second treatment.
Both subjects demonstrated motor control dysfunctions and pain with P/A pressure in the thoracic spine. With the use of DN and IES, immediate reduction was seen in subject perceived symptoms, and pain free ROM was improved. Extended treatment and follow up was not plausible due to the high pace tempo and demands of their operational training schedule. With research indicating the influence of MTrPs on a multitude of musculoskeletal issues and the prevalence of thoracic spine pain, further research is indicated for examining the effects of DN and IES for motor control and painful conditions occurring in the thoracic spine.
Level 4.
病例系列。
肌筋膜触发点（MTrP）在许多肌肉骨骼问题中很常见，并且在非特异性下腰痛和挥鞭样损伤相关疾病患者中都很普遍。触发点干针疗法（DN）已被证明可减轻颈部、腰部、肩部、髋部和膝部等部位的疼痛并改善功能，但尚未在胸椎进行研究。本病例系列的目的是记录在非特异性胸椎疼痛患者中使用DN联合肌内电刺激（IES）的情况。
受试者为两名现役男性军人，年龄分别为31岁和27岁，因胸椎疼痛自行前来接受物理治疗。体格检查显示两名受试者均存在胸椎运动控制功能障碍、组织张力过高以及双侧胸椎旁肌肉触诊压痛。这表明可能存在MTrP。第一名受试者的客观检查结果包括在这些运动平面中的每个平面上进行胸椎屈曲和双侧旋转时疼痛。当通过体位改变减轻脊柱和躯干肌肉的姿势要求时，疼痛减轻。受试者1在T9至T12处由后向前（P/A）按压时出现疼痛。第二名受试者主动进行双侧胸椎旋转受限且疼痛，被动旋转正常，在T4至T7处由P/A按压时出现疼痛。
受试者均接受了两次DN和IES治疗。在P/A测试诱发疼痛的水平对椎旁和多裂肌进行DN治疗，并将IES设置为频率4（1.5Hz），持续20分钟。
受试者1报告站立屈曲时疼痛减轻，初始评估时VAS评分为62mm，第二次就诊时降至26mm。受试者2在第二次治疗后报告GROC症状“好多了”。他在举重活动后的VAS评分从初始评估时的43mm变为第二次就诊时的20mm。两名受试者在第二次治疗后主动胸椎旋转均有10度的改善（受试者1为右侧，受试者2为双侧）。
两名受试者均表现出胸椎运动控制功能障碍以及P/A按压时疼痛。通过使用DN和IES，受试者的自觉症状立即减轻，无痛活动范围得到改善。由于其高强度的训练节奏和作战训练计划的要求，无法进行长期治疗和随访。鉴于研究表明MTrP对多种肌肉骨骼问题有影响以及胸椎疼痛的普遍性，有必要进一步研究DN和IES对胸椎运动控制和疼痛状况的影响。
4级。
