Needling Lower Trapezius Helps Unilateral Neck Pains

Needling the lower trapezius muscle was found beneficial in chronic neck pain. I was so taken with the approach then had to injecting lower trap(with muscle relaxed rather than stretched) that I had to include a pic of actual treatment approach. There are so few controlled studies in myofascial pain that this is exemplary.

lowertrap

Effectiveness of Dry Needling on the Lower Trapezius in Patients With Mechanical Neck Pain: A Randomized Controlled Trial  Original Research Article
Archives of Physical Medicine and Rehabilitation,96(5), May 2015,775-781
Daniel Pecos-Martín, F. Javier Montañez-Aguilera, Tomás Gallego-Izquierdo, Alicia Urraca-Gesto, Antonia Gómez-Conesa, Natalia Romero-Franco, Gustavo Plaza-Manzano

Criteria for inclusion in this study were

  • unilateral neck pain
  • 3  months duration
  • active trigger points in the lower trapezius

exclusions:

  • prior neck trauma
  • cervical radiculopathy
  • prior neck shoulder area surgery
  • primary headache sufferer
  •  trigger point therapy  within the previous 6 months;
  • cognitive deficits
  • needle phobia

Technique:

“the physiotherapist firmly held the lower trapezius muscle in a pincer grasp to precisely locate the trigger point for TrP-DN. Then a monofilament needle was directed upward across the muscle mass as it was held by the fingers to avoid any possibility of penetrating the lung and causing a pneumothorax.  The needle was moved up and down within the muscle, using a “fast-in and fast-out” technique. Needle insertions were repeated 8 to 10 times.” Control group had needling near trigger only.”

lower trap

Results

lowertrap_effectivenessRationale

  • “The mechanical effect of the needle may improve the fiber structure, the localized tissue stiffness, and the local circulation of the biochemical milieu associated with the trigger point.”
  • Improved blood flow
  • Reduced hypooxia – reduced irritating substance P and the calcitonin gene-related peptide.
  • “The high-pressure stimulation of nociceptors during TrP-DN in patients with muscle pain enhanced activity in the somatosensory and limbic regions associated with pain.”
  • Activation of Descending inhibitory pain circuits

Comments –

Failure of any trigger point study might be from the inclusion of subtle radiculitis cases that reactivate trigger points; this study was significantly restricted to avoid that. makes one consider the whole trapezius in unilateral neck issues. I have for years used 5% lidocaine </= 2mls into trigger because it was felt subtle microentrapment of nerves was part of the problem. I also vigorously transverse stretch the muscle sweeping across it. Now I have found I can double the release by pushing tissues transversely with index and middle fingers and thumping between with an activator 20+ times – tissues will gradually let go and you can sweep right through tissues.

activatorTo stretch the lower trap, I have people put affected side  hand on head and pull affected elbow across chest. You can also ischemic pressure with lying on a tennis ball.

 

This entry was posted in Manual Med, Mechanical aids, myofascial pain, Neck, Thoracic. Bookmark the permalink.

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