Pavkovich Ron
Advantage Physical Therapy, Lexington, KY, USA.
Int J Sports Phys Ther. 2015 Feb;10(1):104-13.
Neck pain is a common complaint treated by the physical therapist. Trigger points (TrPs) have been studied as a source of neuromusculoskeletal pain, though the ability of clinicians to accurately locate a TrP is not well supported. Dry needling (DN) is an intervention utilized by physical therapists where a monofilament needle is inserted into soft tissue in order to reduce pain thereby facilitating return to prior level of function. The purpose of this case report is to report the outcomes of DN as a primary treatment intervention for acute, non-specific cervical region pain.
The subject was an active 64-year-old female who self- referred for cervical pain following lifting heavy boxes while moving into a new home. She had a history of multi-level cervical fusion and recurrent cervical pain that physical therapy helped to control over the past few years. Physical examination supported a diagnosis of acute cervical region strain. Objective findings included decreased cervical active range of motion (AROM) and upper extremity strength, as well as, reproduction of pain symptoms upon palpation indicating the likelihood of TrPs in the right upper trapezius, levator scapula, supraspinatus, and infraspinatus musculature. She was treated using DN to the aforementioned muscles for two sessions, and no other interventions were performed in order to determine the effectiveness of DN as a primary intervention strategy without other interventions masking the effects of DN.
Clinically meaningful improvements were noted in pain and disability, as measured by the Neck Disability Index and Quadruple Visual Analog Scale. Physical examination denoted minimal to no change in cervical AROM (likely associated with multi-level fusion), except for right lateral flexion, and no change in shoulder flexion/ abduction MMT.
The patient was able to return to daily and work activities without further functional limitations caused by pain. This case report shows promising outcomes for the use of DN in the treatment of non-specific cervical region strain. Further research is recommended to determine if DN is clinically beneficial independent of other therapeutic interventions/ postural corrections such as general or specific exercises targeting the affected musculature, or other "manual" therapy techniques such as manipulation or non-thrust mobilization.
Level 4.
颈部疼痛是物理治疗师常处理的一种病症。触发点（TrP）已被作为神经肌肉骨骼疼痛的一个来源进行研究，然而临床医生准确定位触发点的能力并未得到充分支持。干针疗法（DN）是物理治疗师使用的一种干预方法，即将单丝针插入软组织以减轻疼痛，从而促进恢复到先前的功能水平。本病例报告的目的是报告将干针疗法作为急性非特异性颈部区域疼痛的主要治疗干预措施的效果。
该患者是一名64岁的活跃女性，在搬入新家时搬重物后自行前来治疗颈部疼痛。她有过多次颈椎融合手术史以及复发性颈部疼痛，在过去几年中物理治疗帮助控制了病情。体格检查支持急性颈部区域拉伤的诊断。客观检查结果包括颈椎主动活动范围（AROM）和上肢力量下降，以及触诊时疼痛症状再现，提示右上斜方肌、肩胛提肌、冈上肌和冈下肌肌肉组织中存在触发点的可能性。对上述肌肉进行了两次干针疗法治疗，未进行其他干预，以便确定在无其他干预掩盖干针疗法效果的情况下，干针疗法作为主要干预策略的有效性。
通过颈部残疾指数和四重视觉模拟量表测量，疼痛和残疾状况有了具有临床意义的改善。体格检查显示，除右侧侧屈外，颈椎AROM几乎没有变化（可能与多节段融合有关），肩屈曲/外展徒手肌力测试（MMT）也没有变化。
患者能够恢复日常和工作活动，且未因疼痛导致进一步的功能受限。本病例报告显示，干针疗法在治疗非特异性颈部区域拉伤方面有良好的效果。建议进一步研究以确定干针疗法是否独立于其他治疗干预措施/姿势矫正（如针对受影响肌肉组织的一般或特定锻炼）或其他“手法”治疗技术（如手法操作或非推力松动术）具有临床益处。
4级。
