Page 54 - Journal of Special Operations Medicine - Winter 2016

it is difficult to conduct effective placebo studies. Even Funding
when practitioners use placebo or sham needling, there The authors have no funding sources to disclose.
is evidence that even minimal palpation may have some
stimulating effect on the mechanoreceptors and the pain
associated with an MTrP. Caution should be used in Disclosures
1
interpreting literature that is largely case based. Al- The authors have no conflicts of interest to disclose.
though the published evidence in support of the poten-
tial benefits of TrP-DN is growing, randomized placebo

controlled trials of larger sample size and studies that References
evaluate the effects of TrP-DN in a methodologically 1. Dommerholt J, Mayoral del Moral O, Grobli C. Trigger point
rigorous and statistically significant way are needed. dry needling. J Man Manipulative Ther. 2006;14:E70–E87.
Although the research presented here is limited, being 2. Shah J, Danoff J, Desai M, et al. Biochemicals associated with
based on anecdotal evidence of and personal experi- pain and inflammation are elevated in sites near to and re-
ence with the success of the therapy and its growing mote from active myofascial trigger points. Arch Phys Med
Rehabil. 2008;89:16–23.
use within civilian and military medicine, we think its 3. Chou L-W, Hsieh Y-L, Kuan T-S, et al. Needling therapy for
potential therapeutic benefit is relevant for the SOF myofascial pain: recommended technique with multiple rapid
community. needle insertion. Biomedicine (Taipai). 2014;4:39–46.
4. Hsieh Y-L, Kao M-J, Kuan T-S, et al. Dry needling to a key
The introduction of TrP-DN into the SOF Medic’s scope myofascial trigger point may reduce the irritability of satellite
myofascial trigger points. Am J Phys Med Rehabil. 2007;86:
of practice would be a step forward in providing the 397–403.
comprehensive care that the SOF population needs. TrP- 5. Bonds T, Baiocchi D, McDonald L. Army Deployments to
DN is a powerful adjunct that will allow patients to be- OIF and OEF. Santa Monica, CA: RAND Corporation; 2010.
gin strengthening and stretching regimens to combat the 6. Association of the United States Army. Annual Meeting:
source of the problem. This is not a panacea treatment U.S. Army Special Operations Forces: Integral to the Army
and the Joint Force. 26 October 2010. http://www.ausa.org
designed to replace traditional physical therapy rehabili- /meetings/2010/annualmeeting/presentations/Documents
tation; rather, it is an important tool to facilitate a faster /AUSA%20SOF%20Panel%2026%20OCT%20(V6).pdf.
return to operational readiness. Because TrP-DN is an Accessed 23 August 2015.
ongoing treatment method, the SOF Medic must be able 7. Alvarez D, Rockwell P. Trigger points: diagnosis and manage-
ment. Am Fam Physician. 2002;65:653–661.
to continue treatment when deployed to locations with- 8. Hauret K, Jones B, Bullock S, et al. Musculoskeletal injuries:
out physical therapists and physicians. Indeed, the Sol- description of an under-recognized injury problem among mil-
dier’s pain in the aforementioned case returned because itary personnel. Am J Prev Med. 2010;38(1 suppl):S61–S70.
the physical therapist was unable to return to the site. 9. Simons DG, Travell JG, Simons LS. Travell & Simons’ myo-
fascial pain and dysfunction: the trigger point manual. 2nd
ed. Baltimore, MD: Williams & Wilkins;1999:94–173.
To effectively minimize risk, there must be a standard- 10. Hong CZ, Hsueh TC. Difference in pain relief after trigger
ized curriculum for all SOF Medics to follow, as well as point injections in myofascial pain patients with and without
strict treatment procedures. With the proper training, fibromyalgia. Arch Phys Med Rehabil. 1996;77:1161–1166.
SOF Medics can be successful in providing this treat- 11. Han SC, Harrison P. Myofascial pain syndrome and trigger-
ment. It is an easy-to-perform, low-risk, highly trans- point management. Reg Anesth. 1997;22:89–101.
portable treatment method. TrP-DN can be executed 12. Ling FW, Slocumb JC. Use of trigger point injections in
chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:
with a handful of acupuncture needles and alcohol 809–815.
swabs, costing essentially nothing when compared with 13. Fricton JR, Kroening R, Haley D, et al. Myofascial pain syn-
the transportation costs of moving an SOF Operator drome of the head and neck: a review of clinical characteris-
requiring TrP-DN around a theater of operations to re- tics of 164 patients. Oral Surg Oral Med Oral Pathol. 1985;
60:615–623.
ceive treatment, or even the loss of an Operator on a 14. Cummings M, White A. Needling therapies in the manage-
team because of injury. ment of myofascial trigger point pain: a systematic review.
Arch Phys Med Rehabil. 2001;82:986–992.
The practice of TrP-DN by physical therapists only be- 15. American Physical Therapy Association. Description of dry
gan in 1989 in the United States. As of 2013, 26 states needling in clinical practice: an educational resource paper.
20
had authorized TrP-DN at the provider level, with sev- 2013. http://www.apta.org/StateIssues/DryNeedling/Clinical
PracticeResourcePaper/. Accessed 23 August 2015. Alterna-
eral more on the way to accepting it as an effective and tive URL: http://www.apta.org/StateIssues/DryNeedling/. Ac-
safe treatment. Although TrP-DN is still not widely ac- cessed 27 September 2016.
20
cepted in either the military or civilian medical world, 16. Maher R, Hayes D, Shinohara M. Quantification of dry nee
we believe that as a community, we can be leaders in dling and posture effects on myofascial trigger points using
providing the effective treatment that our Operators ultrasound shear-wave elastography. Arch Phys Med Rehabil.
2013;94:2146–2150.
need to maximize mission readiness, complete the mis- 17. National Institute of Drug Abuse. Drug Facts: substance
sion, and maintain the long-term health of SOF Soldiers. abuse in the military. http://www.drugabuse.gov/publications

38 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016