Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

CONTEXT: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. CASE PRESENTATION: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). MANAGEMENT AND OUTCOMES: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. CONCLUSIONS: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

A Systematic Dry-Needling Treatment to Support Recovery Posttraining for Division I Ice Hockey Athletes: An Exploration Case Series.

CONTEXT: For this case series, 4 student-athletes (age range = 20-22 years) participating in National Collegiate Athletic Association Division I ice hockey served as cases. They were free of injury and participated in all team activities without restrictions. TREATMENT: A dry needling (DN) lower extremity recovery protocol was completed for all athletes during a single session. To administer the DN recovery treatment, we placed static needles in specific bilateral locations that consisted of 5 points on both the anterior and posterior aspects of the lower extremity and lumbopelvic complex. The Acute Recovery Stress Scale was used to evaluate the effect of the DN recovery treatment on each athlete's perception of recovery at 24 and 48 hours post-DN treatment. RESULTS: Overall, total and average scores of Acute Recovery Stress Scale for all cases were closer to baseline at 48 hours post-DN than at the other time points. CONCLUSIONS: Recovery techniques historically have been used postactivity because even normal training loads, which are considered positive, produce stress and fatigue in athletes and can lead to injury. Results from this case series suggest that ice hockey athletes who are experiencing postexercise stress, such as soreness and fatigue, may benefit from a lower extremity DN recovery treatment protocol.

A Multisegmental Approach to Dry Needling Plantar Fasciitis: A Case Study.

CONTEXT: Plantar heel pain is a common problem affecting foot function, causing pain in the foot under the heel. Plantar fasciitis is commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-stretching home programs, foot orthoses, and night splinting or booting. Dry needling (DN) has shown to be an effective method of treating plantar fasciitis (PF) in multiple randomized control trials. Dry needling is a technique that has been reported to be beneficial in managing pain and dysfunction after PF. Still, there is limited published literature on DN, a myofascial sequence as part of the treatment of PF. CASE PRESENTATION: The patient was a 38-year-old female runner referred by a podiatrist for evaluation and treatment to include DN and therapy for persistent PF in the right foot. She was treated 4 times over 3 weeks with a home exercise program. Management and Outcomes: The DN intervention was beyond the local plantar fascia and incorporated 11 locations from the foot up the posterior chain and 2 electric stim channels. The patient had reduced pain as measured by a visual analog scale, increased function as measured by the functional ankle disability index, and range of motion increases. CONCLUSIONS: This case illustrates the use of DN and a home exercise program to provide a favorable outcome in a patient with PF.

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries.

OBJECTIVE: To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. BACKGROUND: In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. RECOMMENDATIONS: Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.