Page 18 - Journal of Special Operations Medicine - Spring 2016

Dry needling (DN) is a skilled intervention and branch and activities of daily living (ADLs) requiring full cer-
of biomedical acupuncture that is growing in fre- vical range of motion, such as looking overhead or
10
quency of use in PT practice. Dry needling involves over one shoulder.
the application of a fine, filiform needle to body tissues,
producing mechanical and chemical changes to treated At the initial visit, the patient reported a high level of neck
areas. DN promotes changes in muscular, connective, pain, rated at a level of 8–9 out of 10. He complained
and neural tissue function and has demonstrated the of pain-related sleep disruption and a significant re-
ability to reduce somatic pain by diminishing persis- duction in ability to perform usual activities, including
tent peripheral nociceptive input. 11–17 In the treatment administrative work at a computer workstation. There
of cervical spine dysfunction, DN is used to produce were no complaints of radiating pain or muscle weak-
changes in the neuromodulation of pain and to address ness into the extremities. The patient’s symptoms were
shortened or dysfunctional myofascial tissue, thus im- being managed by pharmacotherapeutics, including cy-
proving circulation, decreasing joint compression, influ- clobenzaprine, diazepam, zolpidem, and celecoxib, all
encing motor function of stabilizing musculature, and, taken as needed for sleep and pain management. Ra-
ultimately, improving range of motion and functional diographs taken 2 weeks prior to examination showed
ability. Battlefield acupuncture (BFA) is another type of stable fusion and osteophyte bridging from C7 to T1
biomedical acupuncture that has emerged in military with subchondral sclerosis and osteophyte formation at
medicine for the treatment of pain, and is used by mili- the uncovertebral joints, consistent with degenerative
tary physical therapists. 9,18 Early studies have demon- processes.
strated correlation between stimulation of the external
ear and activation of the somatosensory cortex of the The patient had undergone cervical spine fusion from
brain on functional magnetic resonance imaging stud- C5–C7 10 years prior for these symptoms, with signifi-
19
ies. The auricular acupuncture technique of BFA is lo- cant reduction in pain noted after surgical intervention
calized to the surface of the ear and consists of five small and PT. However, he continued to experience intermit-
needles that remain in place for 2–4 days before they are tent bouts of severe pain with no acute mechanism other
removed or fall out on their own. 20 than repetitive postural stress. The patient recalled two
specific exacerbations in his past where his pain was
Although they are relatively new interventions for the brought on by cervical muscle spasms that intensified to
field of PT, a combined approach of needling techniques the extent that he had visited the emergency department
with established intervention strategies can produce and received morphine for treatment of his symptoms.
significant improvements in function for patients ex- Because of recurrent nature of his symptoms, the pa-
periencing chronic musculoskeletal pain. Additionally, tient’s goals were to experience reduced levels of neck
these new methods may reduce the need for pharmaco- pain and to reduce medication-based pain management
therapies that produce undesirable side-effects and may to optimally perform at his military occupational spe-
compromise function. The purpose of this case study cialty and activities of daily living.
is to report the effects of a PT plan including needling
techniques for a patient poorly responsive to multiple Examination
interventions for chronic neck pain, including pharma- The patient, a tall man with increased thoracic kypho-
cotherapeutics and surgery. The patient was treated over sis and a forward head posture, presented with a severe
several months, then monitored for follow-up response level of pain. He was unable to turn his head greater
over 29 months. than 25% in any direction because of pain, and reported
pain with transitions from standing to sitting, and with
lying down on the examination table. Passive motion
Case Report testing was limited by pain and muscular guarding, but
was greater than 50% in each direction. Significant ten-
Presentation derness to palpation was elicited with small-amplitude
A 51-year-old male field grade officer presented with a posterior to anterior pressure placed on C3–T2 spinal
chief complaint of acute exacerbation of chronic neck segments, with more pain noted on the right side. Hy-
pain to an operational, direct-access PT clinic aboard pertonic and tender bands were palpated in the cervi-
Marine Corps Base Camp Lejeune, North Carolina. cal paraspinals and suboccipitals, as well as the levator
The patient reported a 10-year history of recurrent scapula, scalene, upper trapezius, and infraspinatus
pain exacerbations due to the postural demands of muscles bilaterally. Dermatomal, myotomal, and reflex
prolonged and frequent travel for his occupational testing of the upper extremities revealed no deficits.
specialty, as well as with simple ambulation and po- Testing for upper motor neuron involvement, suggestive
sitional transitions within his workspace. Symptoms of a central cord injury, was negative. Additional testing
were also aggravated by sedentary administrative work was deferred secondary to complaints of pain.

2 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016