Navigating the layers of concern for safe dry needling of the rectus abdominis: a cadaveric study.

OBJECTIVES: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. METHODS: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. RESULTS: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. DISCUSSION/CONCLUSION: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice.

Inferior-Medial Dry Needling at the Thoracolumbar Junction: A Cadaveric Study.

Background: Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas. Purpose: The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction. Study Design: Descriptive Cadaveric study. Methods: The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal. Results: A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior. Conclusion: The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented. Level of Evidence: Level IV.

Safety Considerations When Dry Needling the Multifidi in the Thoracolumbar Region: A Cadaveric Study.

Background: Dry needling the lumbar multifidi is a technique used by physical therapists to effectively treat low back pain. While studies have examined the safety considerations in the upper lumbar spine related to the kidneys and lungs, none have investigated the possibility of entering the spinal canal in this region. Purpose: The purpose of this cadaveric ultrasound-guided dry needling exploration was to determine if a dry needle can penetrate the ligamentum flavum at the T12/L1 interspace and enter the spinal canal using a paramedian approach in a fresh-frozen, lightly fixed cadaver in the prone position. Study Design: Cadaveric study. Methods: The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 50 mm dry needle inserted 1.0 cm lateral to the spinous process of T12 and directed medially at a 22-degree angle could penetrate the ligamentum flavum and enter the spinal canal. Results: As determined via ultrasound, a dry needle can penetrate the ligamentum flavum and enter the spinal canal at the thoracolumbar junction using this technique. Conclusion: This interprofessional collaboration demonstrates that a dry needle can penetrate the ligamentum flavum to enter the spinal canal at T12/L1 using a documented technique for dry needling the multifidus. A thorough understanding of human anatomy along with the incorporation of available technology, such as ultrasound, may decrease the risk of adverse events when dry needling the multifidi at the thoracolumbar junction. Level of Evidence: Level IV.

The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain.

BACKGROUND: Musculoskeletal pain (MSP) is the largest contributor to chronic pain and frequently occurs alongside other medical comorbidities. OBJECTIVE: Explore the relationships between the presence of pain-related comorbidities, pain intensity, and pain-related psychological distress in patients with MSP. METHODS: A longitudinal assessment of individuals 18-90 years old in the Midwestern United States beginning a new episode of physical therapy for MSP. Electronic medical records were assessed the full year prior for care-seeking of diagnoses for pain-related comorbidities (anxiety, metabolic disorder, chronic pain, depression, nicotine dependence, post-traumatic stress disorder, sleep apnea, and sleep insomnia). Pain intensity and pain-related psychological distress (Optimal Screening for Prediction of Referral and Outcome - Yellow Flags tool) were captured during the physical therapy evaluation. Generalized linear models were used to assess the association between pain intensity, psychological distress, and pain-related co-morbidities. Models were adjusted for variables shown in the literature to influence pain. RESULTS: 532 participants were included in the cohort (56.4% female; median age of 59 years, Interquartile Range [IQR]:47, 69). Comorbid depression (beta coefficient (ß) = 0.7; 95%CI: 0.2, 1.2), spine versus lower extremity pain ((ß = 0.6; 95%CI: 0.1, 1.1), and prior surgery (ß = 0.8, 95%CI: 0.3, 1.4) were associated with higher pain intensity scores. No pain-related comorbidities were associated with pain-related psychological distress (yellow flag count or number of domains). Female sex was associated with less pain-related psychological distress (ß = -0.2, 95%CI: -0.3, -0.02). CONCLUSIONS: Depression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.